NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
NATIONAL HEALTH MISSION UTTARAKHAND PROGRAMME IMPLEMENTATION PLAN
A REPORT ON MONITORING OF IMPORTANT COMPONENTS OF HARIDWAR DISTRICT SUBMITTED TO MINISTRY OF HEALTH AND FAMILY WELFARE GOVERNMENT OF INDIA, DECEMBER 2018 DR. WILLIAM JOE MS. MONALI KUMARI
POPULATION RESEARCH1 CENTRE INSTITUTE OF ECONOMIC GROWTH, DELHI-110007
NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
CONTENTS
LIST OF TABLES ...... 4
LIST OF FIGURES/GRAPHS ...... 5
ACKNOWLEDGEMENT ...... 6
ABBREVIATIONS ...... 7
EXECUTIVE SUMMARY ...... 9
1. INTRODUCTION ...... 12
1.1 BACKGROUND AND OBJECTIVES ...... 12
1.2 REVIEW OF THE KEY DEMOGRAPHIC AND HEALTH INDICATORS ...... 15
2. REVIEW OF KEY HMIS INDICATORS ...... 18
2.1 MATERNAL HEALTH ...... 18
2.2 CHILD HEALTH AND IMMUNIZATION ...... 24
3. KEY FINDINGS AND OBSERVATIONS ...... 35
3.1 PHYSICAL ACCESS TO HEALTH FACILITIES ...... 35
3.2 TRANSPORT FACILITY ...... 36
3.3 HUMAN RESOURCES FOR HEALTH: STATUS & TRAINING ...... 36
3.4 TRAINING STATUS ...... 37
3.5 AVAILABILITY OF EQUIPMENTS AND DRUGS IN HEALTH FACILITIES EQUIPMENTS ...... 38
3.6 DRUGS ...... 40
3.7 SERVICE DELIVERY IN LAST TWO YEARS ...... 42
3.8 MATERNAL HEALTH, DELIVERY AND CHILD HEALTH ...... 43
3.9 MATERNAL DEATH ...... 44
3.10 CHILD HEALTH ...... 45
3.11 SNCU, NRC, NBSU, NBCC ...... 45
3.12 RASHTRIYA BAL SWASTHYA KARYAKRAM...... 46
3.13 JANANI SURAKSHA YOJANA & JANANI SHISHU SURAKSHA KARYAKRAM ...... 47
3.14 FAMILY PLANNING ...... 48
3.15 INFORMATION EDUCATION AND COMMUNICATION ...... 48
3.16 COMMUNITY PROCESS ...... 49
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
3.17 DISEASE CONTROL PROGRAMME ...... 49
3.18 HMIS/MCTS ...... 50
3.19 AYUSH ...... 50
3.20 STATEMENT OF NHM EXPENDITURE IN HARIDWAR DISTRICT 2017-18 ...... 50
4. FACILITY WISE OBSERVATIONS ` ...... 51
4.1 DISTRICT HOSPITAL ...... 51
4.2 COMMUNITY HEALTH CENTER BAHADRABAD ...... 54
4.3 COMMUNITY HEALTH CENTER BHAGWANPUR ...... 57
4.4 PRIMARY HEALTH CENTER IMLIKHEDA ...... 60
4.5 PRIMARY HEALTH CENTER BIHARINAGAR ...... 62
4.6 SUB CENTER JAMALPUR KALA ...... 64
4.7 SUB CENTER IMLIKHEDA ...... 66
5. CONCLUSIONS AND RECOMMENDATIONS ...... 67
6. LIST OF CONTACT PERSON ...... 69
7. ANNEXTURE ...... 71
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
LIST OF TABLES
TABLE 1. LIST OF INSTITUTIONS AND FACILITIES VISITED BY THE PRC-IEG TEAM ...... 14 TABLE 2. KEY DEMOGRAPHIC INDICATORS OF HARIDWAR DISTRICT ...... 16 TABLE 3. RURAL-URBAN COMPARISON OF DEMOGRAPHIC INDICATORS: INDIA, UTTARAKHAND AND HARIDWAR ...... 16 TABLE 4. HEALTH INDICATORS OF HARIDWAR DISTRICTS ...... 16 TABLE 5. NUMBER OF PREGNANT WOMEN RECEIVED 3 ANC CHECK-UPS...... 18 TABLE 6. PERCENTAGE OF PREGNANT WOMEN RECEIVED 3 ANC CHECK-UPS...... 18 TABLE 7. PERCENTAGE OF PREGNANT WOMEN RECEIVED TT2 OR BOOSTER TO TOTAL ANC REGISTRATION ...... 18 TABLE 8. PERCENTAGE OF PREGNANT WOMEN GIVEN 100 IFA TO TOTAL ANC REGISTRATION ...... 19 TABLE 9. PERCENTAGE OF PREGNANT WOMEN HAVING SEVERE ANAEMIA (HB <7) TREATED AT INSTITUTION TO WOMEN HAVING TO HB LEVEL <11 ...... 19 TABLE 10. PERCENTAGE OF SBA ATTENDED HOME DELIVERIES TO TOTAL REPORTED HOME DELIVERIES ...... 20 TABLE 11. PERCENTAGE OF MOTHERS PAID JSY INCENTIVE FOR HOME DELIVERY TO TOTAL REPORTED HOME DELIVERY ...... 21 TABLE 12. PERCENTAGE OF WOMEN DISCHARGED IN LESS THAN 48 HOURS OF DELIVERY TO TOTAL REPORTED DELIVERIES AT PUBLIC INSTITUTIONS ...... 21 TABLE 13. PERCENTAGE OF INSTITUTIONAL DELIVERIES TO TOTAL REPORTED DELIVERIES ...... 22 TABLE 14. PERCENTAGE OF HOME DELIVERIES TO TOTAL REPORTED DELIVERIES...... 22 TABLE 15. C - SECTION DELIVERIES (PUBLIC + PRIVATE) TO REPORTED INSTITUTIONAL (PUBLIC + PRIVATE) DELIVERIES ...... 22 TABLE 16. PERCENTAGE OF DELIVERIES CONDUCTED AT PUBLIC INSTITUTION TO TOTAL INSTITUTIONAL DELIVERIES ...... 23 TABLE 17. PERCENTAGE OF WOMEN RECEIVING POST-PARTUM CHECKUP WITHIN 48 HOURS OF DELIVERY TO TOTAL REPORTED DELIVERIES...... 23 TABLE 18. PERCENTAGE OF TOTAL REPORTED LIVE BIRTHS TO TOTAL DELIVERIES ...... 24 TABLE 19. PERCENTAGE OF LIVE BIRTH TO REPORTED BIRTH ...... 24 TABLE 20. PERCENTAGE OF NEW-BORNS GIVEN BCG TO REPORTED LIVE BIRTH ...... 27 TABLE 21. NUMBER OF INFANTS GIVEN PENTAVALENT 1 ...... 29 TABLE 22. NUMBER OF INFANTS GIVEN PENTAVALENT 2 ...... 30 TABLE 23. NUMBER OF INFANTS GIVEN PENTAVALENT 3 ...... 30 TABLE 24. NUMBER OF FULLY IMMUNIZED CHILDREN (9-11 MONTHS) ...... 31 TABLE 25. PERCENTAGE DROP OUT BETWEEN BCG & MEASLES ...... 32 TABLE 26. PERCENTAGE OF CHILDREN GIVEN VITAMIN A DOSE 9 TO CHILDREN GIVEN VITAMIN A DOSE 1 ...... 33 TABLE 27. HUMAN RESOURCES OF HARIDWAR DISTRICT UNDER NHM, 2017 – 18 ...... 37 TABLE 28. TRAINING STATUS OF HEALTH FACILITIES ...... 37 TABLE 29. AVAILABILITY OF EQUIPMENT’S OF THE HEALTH FACILITIES IN 2017 – 18 ...... 38 TABLE 30. AVAILABILITY OF DRUGS OF THE HEALTH FACILITIES IN 2017 – 18 ...... 41 TABLE 31. SERVICE DELIVERY IN YEAR 2017-18 ...... 42 TABLE 32. BLOCK WISE MATERNAL HEALTH INDICATORS OF HARIDWAR DISTRICT 2017 – 18 ...... 43 TABLE 33. MATERNAL HEALTH INDICATORS IN HARIDWAR DISTRICT 2017 – 18 ...... 43 TABLE 34. BLOCK WISE ANALYSIS OF IMMUNIZATION IN THE LAST FINANCIAL YEAR ...... 45 TABLE 35. STATUS OF JSY PAYMENTS IN DISTRICT IN THE LAST FINANCIAL YEAR ...... 47 TABLE 36. FUND UTILIZATION IN THE LAST FINANCIAL YEAR...... 50
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
LIST OF FIGURES/GRAPHS
FIGURE 1. MEETING WITH OFFICIAL DESIGNATED OFFICERS AT HARIDWAR DISTRICT ...... 14 FIGURE 2. MAP OF UTTARAKHAND ...... 15 FIGURE 3. HEALTH INFRASTRUCTURE IN HARIDWAR ...... 35 FIGURE 4. REFERRAL TRANSPORT IN HEALTH FACILITY ...... 36 FIGURE 5. HEALTH EQUIPMENT’S IN THE HEALTH FACILITIES ...... 39 FIGURE 6. DRUGS IN HEALTH FACILITIES ...... 40 FIGURE 7. LABOUR ROOM, OT AND MATERNITY WARD ...... 44 FIGURE 8. NRC, SNCU AND NBCC IN HEALTH FACILITIES ...... 46 FIGURE 9. MEETING WITH ANM AND ASHAS...... 47 FIGURE 10. IEC DISPLAY IN THE HEALTH FACILITIES...... 48 FIGURE 11. HEALTH FACILITY IN DISTRICT HOSPITAL ...... 51 FIGURE 12. HEALTH FACILITY IN CHC ...... 54 FIGURE 13. HEALTH FACILITY IN CHC ...... 57 FIGURE 14. HEALTH FACILITY IN PRIMARY HEALTH CENTRE ...... 60 FIGURE 15. HEALTH FACILITY IN PRIMARY HEALTH CENTER ...... 62 FIGURE 16. HEALTH FACILITIES IN SUB CENTER ...... 64 FIGURE 17. HEALTH FACILITIES IN SUB CENTER ...... 66
GRAPH 1. PERCENTAGE OF NEW-BORNS HAVING WEIGHT LESS THAN 2.5 KG ...... 24 GRAPH 2. PERCENTAGE OF NEW-BORNS BREASTFED WITHIN 1 HOUR OF BIRTH TO TOTAL LIVE BIRTH ...... 25 GRAPH 3. PERCENTAGE OF NEW-BORNS VISITED WITHIN 24HRS OF HOME DELIVERY TO TOTAL REPORTED HOME DELIVERIES .. 25 GRAPH 4. NUMBER OF INFANTS GIVEN OPV 0 (BIRTH DOSE) ...... 26 GRAPH 5. NUMBER OF INFANTS GIVEN BCG ...... 26 GRAPH 6. PERCENTAGE NEW-BORNS GIVEN OPV0 AT BIRTH TO REPORTED LIVE BIRTH ...... 27 GRAPH 7. NUMBER OF INFANTS GIVEN DPT1 ...... 28 GRAPH 8. NUMBER OF INFANTS GIVEN DPT2 ...... 28 GRAPH 9. NUMBER OF INFANTS GIVEN DPT3...... 29 GRAPH 10. NUMBER OF INFANTS GIVEN MEASLES ...... 30 GRAPH 11. VITAMIN - A DOSE 1 ...... 32 GRAPH 12. PERCENTAGE OF CHILDREN GIVEN VITAMIN A DOSE1 TO REPORTED LIVE BIRTH ...... 33 GRAPH 13. PERCENTAGE OF IMMUNISATION SESSIONS WHERE ASHAS WERE PRESENT TO IMMUNISATION SESSIONS PLANNED 34
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
ACKNOWLEDGEMENT
The Monitoring and Evaluation of NHM, PIP Programme Implementation Plan 2018 in Haridwar district, Uttarakhand was successfully completed with the help and support extended by officials and staff of the NHM and State Department of Health and Family Welfare officials.
We are grateful to Dr. Prem Lal, Chief Medical Officer and Mr Ashok Kumar, Assistant Chief Medical Officer of Haridwar District for overall support. We are thankful to the Block Community Programme Manager in Bahadrabad block for help and their cooperation. The monitoring could not have been possible without support from the NHM staff at the district programme management unit.
We are also grateful to the facility staff for their cooperation during the monitoring visits in the Haridwar district. ASHAs, ANMs and beneficiaries also deserve our special thanks for responding to the questions with enthusiasm.
We would like to give our sincere thanks to research fellow Mr. Bibhuti Ranjan for their kind support and help during the NHM PIP visit at Haridwar.
Finally, we sincerely thank the Director of the Institute and the staff of the Population Research Centre at Institute of Economic Growth, Delhi for their kind support and encouragement.
Dr. William Joe
Ms. Monali Kumari
Population Research Centre (PRC – IEG)
Institute of Economic Growth, Delhi – 110007
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
ABBREVIATIONS
Short Name Full Name ANC Ante Natal care ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AYUSH Ayurveda, Yoga& Naturopathy, Unani, Siddha, Homeopathy BB Blood Bank BMOC Basic emergency obstetric care BCC Behaviour change communication BCG Bacillus Calmette Guerin BPL Below poverty line BSU Blood storage unit CDO Computer data entry operator CMO Chief medical officer CGHS Central government health services EMOC Emergency obstetric care ESIC Employee state insurance corporation EVA Equine viral arthritis DGD Delhi government dispensary DOTS Directly treatment strategy DPMU District Programme management unit DPT Diphtheria, Pertussis (whooping cough), Tetanus GOI Government of India HIV Human Immunodeficiency Virus HMIS Health Management Information System ICDS Integrated Child Development Services ICTC Integrated Counseling and Testing Centre IEC Information Education &Communication IFA Iron & Folic Acid IPD Indoor-Patients Department IPHS Indian Public Health Standards IUCD Intra Uterine Contraceptive Device JSY Janani Suraksha Yojna JSSK Janani Shisu Suraksha Karyakram LHV Lady Health Visitor MCH Maternal and Child Health
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
MCTS Mother and Child Tracking System MH Maternity Home MIS Management Information System MOIC Medical Officer In-Charge MTP Medical Termination of Pregnancy NBCC New Born Care Corner NBSU New Born Special Unit NHM National Health Mission NGO Non-Government Organization NRHM National Rural Health Mission NUHM National Urban Health Mission NSSK Navjat Shishu Surksha Karyakram NSV Non Scalpel Vasectomy OBG Obstetrics Gynecology OCP Oral Contraceptive Pill OPD Outdoor Patients Department OPV Oral Polio Vaccine ORS Oral Rehydration Solution PFMS Public Financial Management System PIP Programme Implementation Plan PPIUCD Post-Partum IUCD PHC Post Natal Care RCH Reproductive & Child Health RKS Rogi Kalyan Samiti RTI/STI Reproductive tract infection/Sexually transmitted infection SBA Skilled Birth Attendant (Special training course is available for SBA) TT Tetanus Toxoid VHND Village Health and Nutrition Day
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
EXECUTIVE SUMMARY
HARIDWAR
The Ministry of Health and Family Welfare (MoHFW), Government of India has assigned Population Research Centre (PRC) for quality monitoring of essential components of National Health Mission (NHM) State Programme Implementation Plan (PIP 2018-19). It is expected that a timely and systematic assessment of the key components of NHM can be critical for further planning and resource allocation for any areas. Considering PIP as a major task, Population Research Centre, Institute of Economic Growth, Delhi (PRC-IEG) would identify major concerns in implementation of NHM activities and also monitor quality parameters.
This report presents the key findings from the concurrent monitoring of essential components under NHM in Haridwar district of Uttarakhand. The report is prepared on the basis of field-based observations and visits to selected public health facilities in Haridwar.
The following public health care facilities were visited by the PRC-IEG Team: District hospital, CHC Bahadrabad, CHC Bhagwanpur, PHC Imlikheda, PHC Biharinagar, SC Jamalpur kala and SC Imlikheda. Structured checklist was used to collect information on human resources, infrastructure, funds utilization, training, health care services including drugs and equipment, family planning, disease control programmes, JSY and JSSK programme, Maternal and child health, RBSK programme, and other programmes under the umbrella of NHM.
Interactions with district and block level health administrators including the Chief Medical Officer (CMO) and the Block Medical Officer-in-Charge (MOIC), facility and community level health care providers (ANMs, ASHAs etc) and other supporting staff were conducted to understand the strengths and weakness of the facilities in service provisioning.
Besides, review of relevant programmatic data and information available from the Assistant Chief Medical officer (ACMO), Health Management Information system (HMIS) and the observations made during the monitoring and evaluation of field visit and the key components of NHM are included for robust feedback on programme implementation in the district. The major strengths and weaknesses of the district are as follows:
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
STRENGTHS
1. District women hospital has won second prize from kaya kalp for sanitation and beautification and last year won first prize for the same.
2. Sterilization camp is organised in the CHC Bahadrabad every month and doctors comes from outside for the sterilization.
3. PHC and SC Imlikheda are well maintained as well as cleanliness of these health facilities was good.
4. In both CHCs Bahadrabad and Bhagwanpur delivery room are enhancing for increase the delivery.
5. All registers are maintained in all the visited health facilities.
6. In CHC Bahadrabad under RBSK programme 200 peer educators were selected to give the counselling through the peer educator in village area. Under one ASHA 2 peer educator done their work. Peer educator meeting is held one time in a month. They provide counselling about cleanliness and hygiene practices during period time as well as nutritious food, usage of contraception after the age of 15.
7. In PHC Imlikheda, PHC Biharinagar, SC Jamalpur Kala and Imlikheda pit system were there for bio medical waste and all pits are properly managed health facilities.
8. At sub Centre Imlikheda 1 ANMs and 11 ASHAs were appointed. They had received training on IUCD, NSSK and SBA. They conducted immunization camps at village levels and also provided guidelines related to maternal and child health to the ASHAs.
WEAKNESSES
1. One part of the district hospital is that they have all the type of health facilities and infrastructure available as it works only on Kumbh mela time. On another day it didn’t worked and was not properly closed. This district hospital is 70 bedded.
2. This District hospital has only one MBBS doctor who handled SNCU and NRC section as well as OPD. As he had lots of work load.
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
3. This DWH has also one LMO and she handled OPD, ANC and PNC ward also. But she had lots of workload.
4. With the conversation of CMS, she told that this DWH is 34 bedded and in the condition of overload of delivery they can’t fulfil to provide the health facility to the patient.
5. In CHC Bahadrabad Delivery is conducted in NBSU wing because of construction of Delivery room.
6. In PHC Biharinagar (Sahdevpur) home delivery is very high because surrounding the village women has trust on day of delivery spreading fear about Hospital facilities which is out of pocket expenditure.
7. According to the senior pharmacist in CHC Bhagwanpur shortage of folic acid since the last one month as it can’t be fulfilled till now. MOIC also saying to the patient to borrow some kind of medicine from outside.
8. Misbehaving with ANM in SC Imlikheda from the past two years. Due to that reason delivery was not conducted in this SC from the last one year. As well as Quarters are not available and also power backup is not provided for the staff so now the time delivery is very low here.
9. Toilets were not clean in all visited health facilities like as CHCs, PHCs, and SC.
10. No proper training have been given to the staff such as ASHAs, ANM, and Nurse in all visited health facilities.
11. No power backup facility was available in PHC Biharinagar and SC Jamalpur Kala.
12. Quarters are available only in district hospital, CHC Bahadrabad and CHC Bhagwanpur, any facility of quarters is not visited in PHCs and SCs that’s why doctors and staff can’t stay for long time here.
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
1. INTRODUCTION
1.1 BACKGROUND AND OBJECTIVES
The Ministry of Health and Family Welfare (MoHFW), Government of India has assigned Population Research Centre (PRC) for quality monitoring of essential components of National Health Mission (NHM) State Programme Implementation Plan (PIP 2018-19). Considering PIP as a major task, Population Research Centre, Institute of Economic Growth, Delhi (PRC-IEG) would identify critical concerns in implementation of NHM activities and also evolve suitable quality parameters to monitor the listed components.
This report presents the key findings from the concurrent monitoring of essential components of under NHM in Haridwar district of Uttarakhand. The report is prepared on the basis of field-based observations and visits to selected public health facilities in Haridwar. The following public health care facilities were visited by the PRC-IEG Team: District hospital, CHC Bahadrabad, CHC Bhagwanpur, PHC Biharinagar, PHC Imlikheda, SC Jamalpur Kala and SC Imlikheda. Structured checklist was used to collect information on human resources, infrastructure, funds utilization, training, health care services including drugs and equipment’s, family planning, disease control programmes and other programmes under the umbrella of NHM.
Further, interactions with district and block level health administrators including the Chief Medical Officer (CMO) and the Block Medical Officer-in-Charge (MOIC), facility and community level health care providers (ANMs, ASHAs etc.) and other supporting staff to understand the strengths and weakness of the facilities in service provisioning. Besides, review of relevant programmatic data and information available from the Assistant Chief Medical Officer (ACMO), Health Management Information system (HMIS) and the observations made during the monitoring and evaluation of field visit and the key components of NHM are included for robust feedback on programme implementation in the district.
OBJECTIVE OF THE STUDY
The overall objective of this study is to monitor the functioning of National Health Mission in Haridwar district of Uttarakhand. Especially the study aims to look into the coverage of the mission, constraints during service delivery and utilization of health services by the population of rural and underserved areas at large. Further it seeks to examine the status of utilization of health care services under NHM by the underserved section of the population. The quality monitoring of Programme Implementation Plan (PIP) and some other aspects of 12
NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
the programme have been evaluated in this study which will help the planners and Policy makers to modify the existing policies for better service delivery under the mission. Apart from assessing the availability and adequacy of health services in the study area, the monitoring process intends to assess the performance of the health facilities. The specific objectives of the study are mentioned below:
To assess the adequacy of physical infrastructures like buildings, hospital beds, Ambulances, medical equipment’s and essential drugs needed for better service delivery at the DH, CHC, PHC and SC level.
To assess the availability of human resources and specialists along with their training status working under National Health Mission.
To obtain Block-wise reports on the status of Institutional deliveries, antenatal care, post-natal care, maternal deaths and immunization, family planning in the district
To obtain information about the coverage of beneficiaries under JSSK and JSY of NHM.
To assess the availability of infrastructures and other facilities under Neonatal Health. To obtain the achievements of family planning and immunization against the targets in the district.
To obtain the progress of different programs like RBSK, AYUSH and ARSH functioning under NHM.
To assess the quality in health care services like bio-medical waste management and infection control; community progress like status and activities related to ASHAs; functioning of disease control programs etc.
To understand the utilization of NHM programme budgetary allocations on various components including utilization of untied funds at selected health facilities through Rogi Kalyan Samitis (RKS).
INSTITUTIONS AND FACILITIES VISIT
Health facilities were selected and visited during the 4th week of November, 2018. Table 1 reports the list of institutions and facilities visited in the Haridwar districts. The Team interacted with key programme officials at the Office of the CMO, the DCPM and discussed the status of the key activities. Apart from detailed interactions with
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
the District Nodal Officers and DPMU staff, the team visited selected health facilities in the districts.
Table 1. List of institutions and facilities visited by the PRC-IEG Team
Institutions and Facilities Key Contact Person
Chief Medical Officer Dr. Prem Lal District Programme Management Unit Miss Monika District Hospital Shikha Jangpangi Community Health Centre, Bahadrabad Insar Ali Community Health Centre, Bhagwanpur Dr. vikrant Sirogi Primary Health Centre, Biharinagar Dr. Anita Kaushal Primary Health Centre, Imlikheda Dr. Ashok Kumar Sub Centre, Jamalpur Kala Preety Gola Sub Centre, Imlikheda Sudha Saini
Health facilities from all the three levels (at district, block and village level) were selected for supportive supervision after consultations with the CMO and the ACMO. Further, to understand the health service providers’ perspectives about the services delivery, in-depth discussions were done with the Chief Medical Officer, Block Medical Officer-in-Charge, Medical Officers, ANMs and ASHAs.
Figure 1. Meeting with Official Designated Officers at Haridwar District
Figure 1: Meeting with ACMO, Haridwar Figure 2: Meeting with CMS in DH, Haridwar
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
Figure 3: Meeting with MOiC in CHC, Figure 4: Meeting with MoIC in CHC, Bahadrabad Bhagwanpur
1.2 REVIEW OF THE KEY DEMOGRAPHIC AND HEALTH INDICATORS
Relative to other countries in the world, India can be categorised as a developing country or middle-income country. It is the second largest populous country in the world, after China. It contains 29 states and 7 union territories. Hardwar District, in the Garhwal region is a district of Uttarakhand with its administrative headquarters located at Hardwar city. According to 2011 census, the district encompasses a geographical area of 2360 sq km and has a population of 18, 90,422 (persons) including 10, 05,295 (males) and 8, 85,127 (females). The district has a sex ratio of 880 (females for every 1000 males. The major religions in the district are Hindu (64.27%) and Muslim (34.28%) of the total population respectively. The literacy rate in the district is 73.43% (persons), 81.04% (males) and 64.79% (females). Main spoken languages are Hindi (82.59%), Urdu (15.34%) and Punjabi (1.07%). Labour Force Participation Rate is 30.92%. Main source of income in the district is from the agriculture sector and per capita income is Rs. 1,22,1. The crime rate in the district is 145.63 for the year 2015. Total cropped area is 1, 61,681 in hectares and the forest area are 588 in sq km (2015).
Figure 2. Map of Uttarakhand
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
Table 2. Key demographic indicators of Haridwar district
Indicators India Uttarakhand Haridwar Actual population 1,21,05,69,573 10086292 1890422 Male 62,31,843 5137773 1005295 Female 58,74,47,730 4948519 885127 Sex ratio 940 963 880 Density / km2 382 189 801 Literacy (%) 73.0 78.82 73.43 Male literacy (%) 80.9 87.4 81.04 Female literacy (%) 64.6 70.1 64.79 Source: Supportive supervision checklist, DPMU Haridwar
Table 2 shows that total population in Uttrakhand is 10086292 and that of Haridwar district is 1890422 according to the 2011 census. The proportion of female population is less than that of the male population for both the state and the district. Density of population in Uttrakhand is 189 per sq km which is lesser than the national average.The sex ratio for India which is 940 females per 1000 males, in Uttrakhand it is 963 females per 1000 males and in Haridwar it is 880 females per 1000 males. The Literacy rate for the country as a whole in 2011 was 73 percent for the total population aged 7 years and above, it was 80.9 percent for males and 64.6 percent for females. The literacy rate in Uttrakhand and Haridwar district is higher than the national level
Table 3. Rural-Urban Comparison of Demographic Indicators: India, Uttarakhand and Haridwar
India Uttarakhand Haridwar Description Rural Urban Rural Urban Rural Urban Total population 83,30,87,662 37,71,05,760 7036954 3049338 1197328 693094 Male Population 427.9 (In m) 195.8 3519042 1618731 633784 371511 Female Population 405.1 (In m) 181.3 3517912 563544 563544 321583 Sex Ratio 947 926 1000 884 889 866 Source: Supportive supervision checklist, DPMU Haridwar
Table shows that the proportion of rural urban population in India is 68.84 percent and 31.16 percent respectively. Sex ratio in rural area of the Country and in Uttarakhand is better than urban area, though in Haridwar district the sex ratio is better in rural areas than urban area. The difference between male and female literacy is still high.
Table 4. Health indicators of Haridwar districts
Health Indicator Number Percentage/Ratio NMR 28 per 1000 live birth AHS 2012-13 IMR 40 per 1000 live birth AHS 2012-13 U5MR 48 Per 1000 live birth AHS 2012-13 MMR 165 per 1000 live birth AHS 2012-13 Source: Supportive supervision checklist, DPMU Haridwar
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
The above table shows that the NMR of Haridwar district is 28 per 1000 live births. The NMR is an important indicator for new born care and directly reflects the prenatal and neonatal care. However, the neonatal period, the first 28 days of life carries the highest risk of mortality per day than any other period during the childhood. Infant mortality was 40 per 1000 live birth in Haridwar district in 2012-13. The maternal mortality ratio is 165 per 100,000 live births in Haridwar.
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
2. REVIEW OF KEY HMIS INDICATORS
2.1 MATERNAL HEALTH Table 5. Number of Pregnant women received 3 ANC Check-ups. District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 20,249 29,807 31,745 35,418 35,058 17,535 Bahadrabad 9,332 11,908 11,280 12,202 12,117 5,002 Bhagwanpur 1,866 3,555 4,381 5,633 5,445 3,001 Khanpur 519 813 956 822 963 666 Laksar 2,081 2,852 3,159 3,131 3,267 1,322 Narsan 2,509 4,200 4,629 4,183 4,656 2,357 Roorkee 3,942 6,479 7,340 9,447 8,610 5,187
According to the recent five year HMIS data on 3 and 4 ANC check-ups received by women in the year 2015 – 16 is 35,418 with the highest number compared to the other year of Haridwar District. Whereas in year 2012 – 13 to 2015- 16 table is showing consistency in the data. In Khanpur district, table presents less number of women receiving 3 ANC check-ups in all the year as compared to the other districts. Whereas 2017-18 table represents 4 ANC Check-ups received by women and table also shows the number of women is increasing for taking 4 ANC check-ups.
Table 6. Percentage of pregnant women received 3 ANC Check-ups.
District and blocks 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 Haridwar 61.9 69.4 68.1 70.4 68.8 46.5 Bahadrabad 75.7 80.5 70.3 63.1 67.7 34.2 Bhagwanpur 51.8 63.1 68.2 85.3 83.0 60.7 Khanpur 44.9 64.3 66.9 66.5 73.5 65.1 Laksar 51.0 60.2 61.4 70.0 67.4 43.2 Narsan 53.1 58.6 59.6 59.4 59.7 46.1 Roorkee 57.9 69.6 74.9 81.5 68.7 58.2
The given bar diagram represents the percentage of pregnant women received 3 ANC check- ups and it was found that total 70.4 % had covered in the year 2015 – 16 in Haridwar district. Only 59.4 %women used 3 ANC check- ups to total the ANC registration in Narsan during their pregnancy in the year 2016-17. The highest % has covered in the year 2014 – 15; which was 85.3 % in Bahadrabad. In some of the sub district of Haridwar there has been regular increase in ANC check-ups during the year 2012 – 13 to 2015 - 16. According to 2017-18 data % of 4 ANC check-ups is also increasing the entire sub district, because of awareness of the maternal and child health care.
Table 7. Percentage of pregnant women received TT2 or booster to total ANC registration 18
NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 73.4 85.2 86.8 84.7 85.1 86.0 Bahadrabad 71.7 87.2 87.6 77.5 83.9 73.9 Bhagwanpur 76.7 89.5 91.6 94.8 95.4 101.5 Khanpur 75.2 91.2 92.9 89.0 90.2 96.7 Laksar 74.9 84.4 86.1 87.0 87.5 86.2 Narsan 68.1 80.8 84.4 88.5 86.6 97.8 Roorkee 77.4 82.5 83.8 87.6 79.1 89.4
Most of the countries followed a universal standard for Tetanus Toxoid (TT) immunization for mother health care. The proportion of women who received TT2 or Booster, in Bhagwanpur district; table presents percentage of data increased continuously in every year. According to the HMIS data in the year 2017-18 in Bhagwanpur sub district, 101.5% TT2 or Booster were received by pregnant women. In Bahadrabad and Khanpur 2015 – 16 covered low percentage compared to the 2014 – 15, which is 77.5% . In 2015 – 16 and in 2014 – 15 same sub district is 87.6 percentage; whereas in Khanpur 89.0 % is in 2015 – 16 and 92.9 % is in 2014 – 15.
Table 8. Percentage of pregnant women given 100 IFA to total ANC registration
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 41.0 83.6 57.3 70.3 18.6 59.1 Bahadrabad 47.9 86.8 62.7 89.7 30.0 95.3 Bhagwanpur 37.4 96.9 68.6 62.1 2.4 28.9 Khanpur 15.2 93.4 69.0 51.9 10.8 40.2 Laksar 19.8 81.5 45.1 56.4 1.5 21.3 Narsan 35.6 71.8 54.7 39.0 4.9 67.6 Roorkee 51.4 79.6 48.0 69.0 27.1 27.0
As per WHO pregnant women requires additional iron and folic acid to meet their own nutritional needs as well as those of the developing foetus. Figures from the table tell us about percentage of pregnant women who received 100 IFA to Total ANC Registration. In the year 2016 – 17 pregnant women who received 100 IFA to total ANC registration during pregnancy is 18.6 % is lowest compared to the other fiscal year. In 2016-17 all sub districts of Haridwar also presenting lowest percentage were compared to the other fiscal year. Figure shows inconsistency in data of Haridwar and sub districts in all the year. Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth. Table 9. Percentage of pregnant women having severe anaemia (Hb <7) treated at institution to women having to Hb level <11
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District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 7.1 5.0 6.1 5.1 4.3 28.8 Bahadrabad 8.3 2.8 5.1 6.7 6.1 44.5 Bhagwanpur 9.3 15.3 3.4 0 0.1 9.1 Khanpur 0 0 0.8 1.7 0 - Laksar 0 0 7.7 0 0 0 Narsan 0 6.9 20 15.1 1.8 0 Roorkee 6.7 13.7 9.2 2.6 2.8 21.2
In the present HMIS data, the prevalence of % Pregnant women having severe anaemia (Hb<7) treated at institution to women having Hb level<11 anaemia is missing in some sub district like as, Khanpur and Laksar of Haridwar. Also about other sub districts, figure is showing percentage of anaemia is very low, and also found inconsistency of data. There has been a substantial increase in percentage relative to other fiscal years, in the year 2017-18 with range of about 28.8 %, 44.5 %, and 21.1 % in Haridwar and two another districts Bahadrabad and Roorkee.
Table 10. Percentage of SBA attended home deliveries to total reported Home deliveries
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 27.4 24.4 21.8 21.0 16.4 12.9 Bahadrabad 36.2 20.2 16.6 24.3 10.0 7.4 Bhagwanpur 11.0 10.6 14.2 12.6 15.7 5.7 Khanpur 14.3 12.5 11.8 15.8 11.2 15.3 Laksar 12.1 13.3 9.7 19.2 9.1 8.6 Narsan 53.4 51.1 52.0 45.5 49.9 37.1 Roorkee 20.3 24.6 19.5 11.6 7.4 9.4
According to the figure percent SBA attended home deliveries to total reported home deliveries is continuing decreasing and it could be seen in Bhagwanpur district from the year 2012-18, because of proper women educated, government programme, and also health conscious of women during pregnancy. Hitherto, the lowest percentage from the data is for Haridwar that is 12.9 % in the year 2017-18, but there has been a remarkable decrease. Data suggest that Narsan district has highest turned up in all the year compared to the other sub districts. Besides this government should focus on poor uneducated and younger rural women as well as it should ensure at least four ANC visits for every pregnant woman as well. So that maternal mortality can be combated on time.
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
Table 11. Percentage of mothers paid JSY incentive for home delivery to total reported home delivery
District and blocks 2012-13 2013-14 2014-15 2015-16 2016-17 Haridwar 4.8 6.2 6.4 1.7 4.2 Bahadrabad 4.1 3.8 4.9 1.1 3.6 Bhagwanpur 11.2 9.7 8.3 0 7.1 Khanpur 4.6 15.4 30.5 11.4 24.5 Laksar 7.8 13.4 12.3 8.6 8.7 Narsan 6.8 6.8 4.8 1.0 0.4 Roorkee 0.2 0.2 0.9 0 0.6
Building on the phenomenal progress of the (under the JSY scheme, Janani Shishu Suraksha Karyakram (JSSK, launched in 2011) provides service pregnant women, sick new-borns and infants for free delivery including caesarean section and free treatment in public health institutions. This includes free to free transport between home and institution, diet, diagnostics, drugs, other consumables and blood transfusion if required. Figure from the table tell us about % Mothers paid JSY incentive for home delivery to total reported home delivery. Year 2015 – 16 shows lowest percentage to women received JSY incentives for home delivery in all sub districts including Haridwar compare to other fiscal year. Roorkee also presented lowest percentage in all the year compare to the other districts. For rest of the sub-districts the data is very inconsistent and the percent fluctuates in all the districts. Data is not available in the year 2017 – 18.
Table 12. Percentage of women discharged in less than 48 hours of delivery to total reported deliveries at public institutions
District and blocks 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 Haridwar 13.0 6.2 9.4 13.6 8.8 61.6 Bahadrabad 15.9 3.3 7.3 10.2 7.2 72.5 Bhagwanpur 0 0 30.2 30.8 9.0 36.7 Khanpur 100.0 0 100.0 85.6 100.0 53.6 Laksar 15.9 12.5 29.5 38.8 39.0 17.0 Narsan 10.7 13.8 5.0 0 0.5 25.4 Roorkee 8.3 4.5 2.7 16.3 4.0 90.5
In Khanpur district 100 % of achievement in the year 2012 – 13, 2014 – 15 and 2016 – 17, women discharged in less than 48 hours of delivery to total reported deliveries at public institution. In the Narsan sub-district showing the decreased percent of women discharged in less than 48 hours of delivery to total reported deliveries at the public institution, in the given year (2014-15, 2015-16, and 2016-17), which is 5%, 0% and 0.5% respectively.
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
Table 13. Percentage of institutional deliveries to total reported deliveries
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 59.8 66.6 69.7 77.1 72.1 79.1 Bahadrabad 81.0 86.6 86.8 90.6 87.8 92.6 Bhagwanpur 26.3 22.3 23.0 27.2 32.9 28.9 Khanpur 0.2 0 4.8 51.6 40.5 65.3 Laksar 46.3 55.6 56.4 56.5 45.4 58.7 Narsan 43.0 45.2 53.6 71.0 65.5 69.7 Roorkee 31.4 47.5 54.5 55.7 53.0 53.8
Percentage of Institutional deliveries to total reported deliveries is highest in Bahadrabad sub district of Haridwar, which is 92.6 % in the year 2017-18. But in the year 2013-14 and 2014- 15, in Khanpur percentage was found very low compared to the other district, which is negligible In Bahadrabad.
Table 14. Percentage of home deliveries to total reported deliveries
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 40.2 33.4 30.3 22.9 27.9 20.9 Bahadrabad 19.0 13.4 13.2 9.4 12.2 7.4 Bhagwanpur 73.7 77.7 77.0 72.8 67.1 71.1 Khanpur 99.8 100.0 95.2 48.4 59.5 34.7 Laksar 53.7 44.4 43.6 43.5 54.6 41.3 Narsan 57.0 54.8 46.4 29.0 34.5 30.3 Roorkee 68.6 52.5 45.5 44.3 47.0 46.2
The study revealed that in spite of the efforts in this direction, decreasing trend has been identified from 2013 to 2018; this was the situation in a village located in the periphery of a state capital that had easy access to all the health facilities. During the year 2017 -18 it is clearly observed that mostly home delivery had reported in Bhagwanpur.
Table 15. C - Section deliveries (public + private) to reported institutional (public + private) deliveries
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 10.5 12.7 10.2 12.1 8.2 13.4 Bahadrabad 13.6 16.2 13.0 16.8 11.6 18.3 Bhagwanpur 0 0 0 0 0 0 Khanpur 0 0 0 0 0 0 Laksar 0 0 0 0 0 0 Narsan 0 0 0 0 0 0 Roorkee 7.2 11.3 8.8 2.6 2.5 0
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Percentage C-Section deliveries (Public and Private) to reported institutional (Public and Private) deliveries, data are not available in four sub district of Haridwar. In the district of Bahadrabad during the year 2017- 18 percentage of c- section deliveries increased compared to the 2016-17, and also the percentage fluctuation of increasing and decreasing was from the year 2012 to 2018.
Table 16. Percentage of deliveries conducted at public institution to total institutional deliveries
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 53.5 52.4 55 55.1 58.5 53.7 Bahadrabad 36.3 32.9 35.5 36.7 39.5 37.0 Bhagwanpur 100.0 100.0 100.0 100.0 100.0 100.0 Khanpur 100.0 - 100.0 100.0 100.0 100.0 Laksar 100.0 100.0 100.0 100.0 100.0 100.0 Narsan 100.0 100.0 100.0 100.0 100.0 100.0 Roorkee 100.0 100.0 100.0 100.0 100.0 100.0
In Haridwar district Percentage deliveries conducted at public institutions to total institutional deliveries table showing continuously increasing percentage from the year 2012 - 18 but rest of Bahadrabad district and all other sub district covering 100 % results. Year 2012 – 13 to 2017 – 18 percentages varies between 32-37 % in the sub district of Bahadrabad.
Table 17. Percentage of women receiving post-partum checkup within 48 hours of delivery to total reported deliveries.
District and blocks 2012-13 2013-14 2014-15 2015-16 2016-17 Haridwar 67.8 89.9 70.0 53.5 88.4 Bahadrabad 69.9 107.0 69.3 52.0 102.1 Bhagwanpur 44.7 51.5 55.5 58.1 64.3 Khanpur 42.7 52.4 67.3 83.9 82.1 Laksar 69.6 83.7 98.0 84.8 91.6 Narsan 67.8 49.9 40.4 19.8 44.2 Roorkee 73.2 85.2 85.3 69.5 85.0
In Bhagwanpur district percentage of women receiving post-partum check-up within 48 hours of delivery to total reported deliveries is continuously increasing all the year. But the other district percentage varies from year to year. Also, in some district data is not available in this context.
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2.2 CHILD HEALTH AND IMMUNIZATION
Table 18. Percentage of total reported live births to total deliveries
District and blocks 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 Haridwar 97.9 99.8 99.2 99.1 99.8 98.8 Bahadrabad 93.3 99.2 99.7 99.1 99.8 99.7 Bhagwanpur 99.4 98.1 99 98.9 100 98.2 Khanpur 99 100.7 98.9 98.7 99.3 101.8 Laksar 102.2 98.9 99.4 99.8 103.7 98.4 Narsan 115.4 107 98.1 99.1 99.4 98.3 Roorkee 96.8 97.9 98.5 99 98.6 95.6
The table is representing the percentage of total reported live births to total deliveries. Almost 100 % reporting is covering from Hardwar and sub districts in all the year. All other sub-districts have shown marginally fluctuating result for in all the year.
Table 19. Percentage of live birth to reported Birth
District and blocks 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 Haridwar 98.4 98.6 98.8 98.7 98.9 99 Bahadrabad 98.5 98.9 99.1 99.1 99.2 99.3 Bhagwanpur 98.7 98.2 98.5 99.1 99.5 98 Khanpur 99.7 99 98.7 96.9 99.3 97.2 Laksar 98.9 98.5 99.1 98.4 99.3 98.7 Narsan 97.8 98.7 98.4 98.1 98 98 Roorkee 97.7 97.3 98.3 97.7 98 98.8
The table is showing percentage of live birth to Reported Birth from the year 2012 to 2018. Digits in the table shows percent live birth to reported birth and it indicates that there has been consistent increase in all the sub- districts with figures in between 97-100%.
Graph 1. Percentage of new-borns having weight less than 2.5 kg
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
The graphs show that the proportion of percent new-borns having weight less than 2.5 kg to new-borns weighed at birth in Hardwar district is 11.8% in the year 2013 – 14. Whereas in the year 2012 – 13 Khanpur sub-district had lowest percent as compare to all other sub-districts. While looking into the recent year data 2017-18 Laksar is reported higher percent of new-born who weight is less than 2.5 kg and very low in Narsan sub-district of Haridwar.
Graph 2. Percentage of new-borns breastfed within 1 hour of birth to total live birth
The graph shows that the proportion of percent New-borns breastfed within 1 hour of birth to total live birth. It shows that in year wise as well as sub-district of Haridwar above 50 percent and above new-borns had breastfed within 1 hours. While in the year 2015-16 maximum percentage observed in the sub-district of Khanpur and almost similar trends and pattern are found in all sub-district.
Graph 3. Percentage of new-borns visited within 24hrs of home delivery to total reported home deliveries
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
The line diagram shows the percentage of new-borns visited within 24hrs of home delivery to total reported home deliveries and line clearly indicates there are variation in year wise data. While the lowest district is Bhagwanpur where new-borns visited approximately 30 percent and for the highest it is in the sub-district of Roorkee. However, for all the years the percentage indicate somehow fluctuating results.
Graph 4. Number of infants given OPV 0 (birth dose)
Many communicable diseases that kill millions of children are easily preventable through timely immunization. Children must be immunised in the first week after birth and the full schedule of immunisation should be completed before the first birthday. The HMIS Data indicate that 23,868 children in Haridwar are taking OPV0 by birth in the year 2012-13. Whereas in the sub-district Khnapur number of 124 children given OPV 0 by birth which is the lowest figure in the year all years. While compression between within the sub-district of Haridwar provide us good understanding for the child health performance. Also, results suggested that some sub-district are performing well and few sub-district are less.
Graph 5. Number of infants given BCG
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
The graph indicates that 39660 infants given BCG by birth in the year 2015-16 in Haridwar district. Data also, indicate that in the sub-district of khanpur with the lowest number of infants who received BCG by birth in the year 2017-18. While others sub-district figure is showing lowest number of infants who given BCG doses compare to the other sub-districts as well as year wise.
Graph 6. Percentage new-borns given OPV0 at birth to reported live birth
The graph shows the percentage of new-born given OPV0 at birth and it is found that the maximum number of infant for the sub-district of Bhagwanpur have received OPV 0 vaccination as compare to all sub-districts. While it is also low in the Haridwar districts. While in the sub-district Lasker during the 2012-13 there are only 25 percent numbers of infant reported for OPV 0 to reported live birth and it is almost same for the Khanpur sub-district during the year 2013-1. Overall the graphs showing increasing trends for percentage of new- born receiving OPV dose and it is clearly seen in the recent year 2017-18 only three district have less than 80 percent, which are Bahadrabad, Laskar and Haridwar district.
Table 20. Percentage of new-borns given BCG to reported live birth
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 147.7 123.1 122.1 137.2 127.5 125.8 Bahadrabad 137.6 78.5 70.5 78.7 69.4 61.7 Bhagwanpur 214.3 228.7 221.2 265.4 320.3 363.4 Khanpur 175 163.9 231.9 221.3 241.1 255.5 Laksar 158.8 162.7 181.2 222.1 192.3 201.1 Narsan 116.6 161.1 205.9 194.8 185.9 190.9 Roorkee 169.5 172.9 163.1 199.1 209.3 238.4 27
NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
The line graph indicates that percentage of new-borns given BCG to reported live birth and it is clearly found that in the sub-district Bhagwanpur only increasing trends have observed. While other sub-district like Lasker and Roorkee are more or less similar type of trends are observed.
Graph 7. Number of Infants given DPT1
The bar diagram shows that the total number of infants given DPT1. The data reveal that only three-year time period data is available in the HMIS portals. Whereas for the recent year from 2015 onward there is unavailability of data. Also, during the year 2012 to 2015 very less number of infant received DPT1 in all blocks.
Graph 8. Number of Infants given DPT2
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The bar diagram revelled that number of total infant given DPT2. While due to data not available of recent year it is difficult to compare with other years. While in the sub-districts of Bhagwanpur only highest number of infant who received DPT2. Whereas other sub-district is below 10000 infant report in all the year during 2012- 2015.
Graph 9. Number of Infants given DPT3
The bar diagram represents the number of infant given DPT3. In the year 2013-14 only Haridwar district have above 35 thousand and above infants reported who received DPT3 dose. While other sub-district of Haridwar have register very less number. Which is also, seen in the DPT1 and DPT2 dose.
Table 21. Number of Infants given Pentavalent 1
District and blocks 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 Haridwar 0 0 9,821 41,681 40,533 30,342 Bahadrabad 0 0 3,300 13,604 13,712 9,619 Bhagwanpur 0 0 1,366 5,931 6,126 4,952 Khanpur 0 0 287 1,117 1,074 919 Laksar 0 0 1,132 4,259 3,893 2,367 Narsan 0 0 1,710 7,440 6,603 5,126 Roorkee 0 0 2,026 9,330 9,125 7,359
The table represent that number of infants given pentavalent 1 dose. It is observed that in all the sub-district of Haridwar increasing trends have identified. While during the recent year 2017-18 the maximum number of infant received dose in the Baradrabad sub-district. While the lowest one is identify in the sub-district of Khanpur 919 followed by Lasker 2367 and Bhagwanpur 4952.
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Table 22. Number of Infants given Pentavalent 2
District and blocks 2014-15 2015-16 2016-17 2017 - 18 Haridwar 4,537 39,848 39,116 29,512 Bahadrabad 1,748 12,966 13,576 9,347 Bhagwanpur 538 5,694 5,676 4,755 Khanpur 144 1,145 1,040 918 Laksar 552 4,181 3,607 2,285 Narsan 640 7,003 6,333 5,107 Roorkee 915 8,859 8,884 7,100
The table represent that number of infants given pentavalent 2 dose. It is observed that in all the sub-district of Haridwar increasing trends have identified. While during the recent year 2017-18 the maximum number of infant received dose in the Baradrabad sub-district. While the lowest one is identify in the sub-district of Khanpur 918 followed by Lasker 2285 and Bhagwanpur 4735.
Table 23. Number of Infants given pentavalent 3
District and blocks 2014-15 2015-16 2016-17 2017 - 18 Haridwar 1,387 38,192 38,936 29,397 Bahadrabad 563 12,427 13,578 9,016 Bhagwanpur 181 5,434 5,726 4,767 Khanpur 44 1,122 1,003 908 Laksar 156 4,079 3,591 2,473 Narsan 155 6,784 6,182 4,989 Roorkee 288 8,346 8,856 7,244
The table indicates number of infant given pentavalent 3 and it is clearly observed that during 2014-15 onward increasing trends. While in the year 2017-18 very less number of infants received Pentavalent 3 comparatively 2016-17. Whereas in sub-district of Khanpur is very low number of infant received pentavalent 3.
Graph 10. Number of Infants given Measles
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NHM, Uttarakhand PIP 2018-19: M&E Report, Haridwar PRC-IEG, Delhi
The bar diagram shows that number of infant received measles in the Haridwar and sub- districts, it is clearly observed that only Sub-district Bahadrabad have highest number infants received measles during all the years. While Khanpur sub-district have very less number of infants received measles in all the years. The overall performance of sub-district of Haridwar is bad in context of measles given to infants.
Table 21. Percentage of Infants 0 to 11 months old who received Measles vaccine to reported live births
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 102.6 104.8 110.8 147.9 136.6 90.2 Bahadrabad 70.1 68.3 68.4 88.2 78.2 47 Bhagwanpur 185.5 203.1 221.1 286.7 351.1 274.5 Khanpur 156.9 198.2 276.9 259.2 263.5 177.5 Laksar 127.8 144.1 158 246.5 207.9 169.9 Narsan 99.9 123.9 175.6 197.5 184.4 128.3 Roorkee 152.7 139.3 129.8 207.5 216.3 151.9
The table indicate that percentage of infants 0 to 11 months old who received measles vaccine. In the table clearly observed the increasing trends of children who received vaccine. While sub-district comparison Bahadrabad is reported very less percentage in the respective years. Whereas the maximum percentage had observed in the sub-district of Bhagwaqnpur.
Table 24. Number of fully immunized children (9-11 months)
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 25,003 31,380 35,109 42,675 40,823 19,012 Bahadrabad 8,737 10,882 12,202 14,368 14,061 5,597 Bhagwanpur 2,658 4,255 5,030 5,822 5,684 3,115 Khanpur 977 1,189 1,196 1,156 1,091 578 Laksar 2,758 3,887 3,851 4,543 3,870 1,758 Narsan 4,284 4,449 6,013 7,280 6,570 3,241 Roorkee 5,589 6,718 6,817 9,506 9,547 4,723
The bar diagram represents number of fully immunized children 9-10 months. It is clearly found that in sub-district Bahadrabad the maximum numbers of children are fully immunized and also increasing trends were observed. While considering the recent year data 2017-18 the less number of children reported for the fully immunized. While overall in Haridwar district were indicate maximum 40,000 and above number of children are immunized.
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Table 25. Percentage drop out between BCG & Measles
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 30.5 14.8 9.2 -7.8 -7.2 31.7 Bahadrabad 49.1 13 3 -12.2 -12.7 34.3 Bhagwanpur 13.4 11.2 0.1 -8 -9.6 24.5 Khanpur 10.3 -20.9 -19.4 -17.1 -9.3 30.5 Laksar 19.5 11.4 12.8 -11 -8.2 15.5 Narsan 14.4 23.1 14.7 -1.4 0.8 32.8 Roorkee 9.9 19.4 20.4 -4.2 -3.3 36.9
The table represent the percentage of drop out BCG and Measles, whereas dropout rate is determined using coverage’s of BCG as entry vaccine and Measles as exit vaccine. However, in the exiting data for the district of Haridwar during the recent years 2017-18, it is found that approximately 31.7 percent of children dropout for the BCG and Measles. While in other sub- district of Haridwar between the 2013-14 to 2016-17 there were negative values are observed. Whereas sub-district like Roorkee and Bahadrabad recorded highest dropout in the year 2017-18. This reflects the current as well as future situation of the district.
The bar diagram represent the scenario of Vitamin-A Dose 1 children received in the district of Haridwar. The picture clearly indicates that there is huge variation have been in all the sub- district of Haridwar. Whereas it is found that maximum number of vitamin-A dose given in only Bahadrabad district and the lowest in Khanpur during the year 2015-16.
Graph 11. Vitamin - A dose 1
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Graph 12. Percentage of children given vitamin A dose1 to reported live birth
The bar diagram shows the percentage of Children given Vitamin A dose 1 to reported live birth in the district of Haridwar. It is found that maximum number children received vitamin dose in the year 2015-16 in all the sub-district of Haridwar and the maximum percentage is reported in the Bhagwanpur and Khanpur sub-district. While during the year 2016-17 data shows the percentage of children given vitamin A dose is decrease and the very less percent is reported in the Bahadrabad sub-districts of Haridwar.
Table 26. Percentage of children given vitamin A dose 9 to children given vitamin A dose 1
District and 2012-13 2013-14 2014-15 2015-16 2016-17 2017 - 18 blocks Haridwar 15 19.9 6.1 7.6 16.6 11.4 Bahadrabad 11.7 29.6 3.2 10.1 18.9 0 Bhagwanpur 12.1 3.1 22.7 0 0 Khanpur 44.6 150 0 0 0 Laksar 38.3 150.7 0 0 0 0 Narsan 25.8 13 5.5 0 5.3 0 Roorkee 8 0 1.8 15.8 31.9 15.9
The bar diagram shows the percentage of Children given Vitamin A dose 9 to given vitamin A dose 1 in the district of Haridwar. It is found that maximum number children received vitamin A dose 9 in the year 2013-14 in all the sub-district of Bahadrabad and Haridwar. While data is not comparable for the year 2014 onward and there are less number of percentage is reported in all sub-districts.
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Graph 13. Percentage of immunisation sessions where ASHAs were present to immunisation sessions planned
The line diagram is representing the percentage of immunisation sessions where ASHAs were present to immunisation session. It is varying between 60 to 80 percent were immunisation sessions is performed in all sub-district. Whereas the lowest percentage is found in Bahadrabad during the year 2016-17. While in the Narsan sub-district maximum percentage reported during the year 2017-18. However, the data also indicate increasing pattern as compare to 2016-17 in all the sub-district of Haridwar.
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3. KEY FINDINGS AND OBSERVATIONS
3.1 PHYSICAL ACCESS TO HEALTH FACILITIES District hospital, CHC Bahadrabad, CHC Bhagwanpur, PHC Biharinagar, PHC Imlikheda, SC Jamalpur Kala and SC Imlikheda are running under government building. CHC Bahadrabad and Bhagwanpur enhancing their labour room. Only 3 delivery points is in CHC Bahadrabad, and overloaded of delivery could see because of lack of delivery point. District hospitals are separated in two parts such as: district women hospital and general district hospital. Building condition of our visited health facilities is good. Whereas water and electricity facility was also good. In absence of electricity health facilities have power backup through generator. Figure 3. Health infrastructure in Haridwar
Figure 1: CMO office, Haridwar Figure 2: District hospital, Haridwar
Figure 3: CHC, Bahadrabad Figure 4: CHC, Bhagwanpur
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Figure 5: PHC, Bihari Nagar Figure 6: Health & wellness centre, Imlikhera
3.2 TRANSPORT FACILITY In DWH one 108 and one 102 ambulance facility was available, where as in CHC Bahadrabad only one 108 ambulance facility was there. While at CHC Bhagwanpur one 102 and one 108 facilities was available. Whereas all type of drugs and equipment’s is being available in ambulance. As in visited SCs which was delivery point’s ambulance facility were available. Figure 4. Referral transport in health facility
Figure 1: Referral transport in district hospital Figure 2: Referral transport in CHC, Bhagwanpur
3.3 HUMAN RESOURCES FOR HEALTH: STATUS & TRAINING In district Haridwar HR is the main concern in behalf of health facilities. Infrastructure was available but lack of HR is affecting health facilities. In all visited health facilities specialist doctor and general surgeon are not available. Only one gynaecologist are available in DWH, so she couldn’t handle all C-section and OT. Also CHCs are in same condition. In SC Imlikheda there are not any ANM and staff nurse are available from last one and a half year. From the last three months one staff nurse joined. In PHC Biharinagar MOIC positon are vacant from the last 2 years.
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Table 27. Human resources of Haridwar district under NHM, 2017 – 18
In position In position In position Position Name District hospital CHC Bahadrabad CHC Bhagwanpur MO's 2 2 2 Gynaecologists 1 - - Paediatrician 1 - - Surgeon - - - Nutritionist 1 - - Dental Surgeon 1 - - LHV 1 1 1 ANM 1 1 1 Pharmacist 3 2 2 Lab Technicians 1 1 1 X-Ray Technicians - - - Data Entry Operators 2 1 1 Staff Nurse 11 - 3 Sources: Supportive supervision checklist, DPMU Haridwar
3.4 TRAINING STATUS In district women hospital they have not manitended proper record of training status. According to CMS for SBA, IUCD and PPIUCD training happens. In CHC Bahadrabad in SBA, MTP/MVA, IUD, RTI/STI and immunization and cold chain training is provided. In CHC Bhagwanpur training provides in SBA, NSSK, IUCD and PPIUCD. Whereas in PHC Imlikheda SBA, NSV, NSSK, IUD, RTI/STI, Immunization and cold only 1 training provide in these section. In PHC Biharinagar doctors and staffs have not received any training program during the last financial year.
Table 28. Training status of health facilities
District CHC CHC PHC Training PHC Biharinagar hospital Bahadrabad Bhagwanpur Imlikheda EmOC - - - - - LSAS - - - - - BeMOC 1 1 - - - SBA 1 1 1 - 1 MTP/MVA 1 - - - - NSV 1 - - - 1 F-IMNCI - - - - - NSSK - - 1 - 1 Mini Lap - - - - - IUD - 1 1 - 1 IUCD - 1 1 - - PPIUCD 1 1 - - - RTI/STI 1 1 - - 1 Immunization and cold chain 1 - 1 1 1 Blood storage 1 - - - - Others - - - - -
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3.5 AVAILABILITY OF EQUIPMENTS AND DRUGS IN HEALTH FACILITIES EQUIPMENTS Availability of necessary equipment is important for all health institution. In this section we are discussing about the availability of necessary equipment in the selected health facility.
Table 29. Availability of equipment’s of the health facilities in 2017 – 18
Districts CHC CHC PHC PHC Equipment Hospital Bahadrabad Bhagwanpur Biharinagar Imlikheda Functional BP Instrument and Stethoscope √ √ √ √ √ Sterilised delivery sets √ √ √ x √ Functional Neonatal, Paediatric and Adult Resuscitation kit √ x √ x √ Functional Weighing Machine (Adult and child) √ √ √ √ √ Functional Needle Cutter √ √ √ √ √ Functional Radiant Warmer √ √ x √ √ Functional Suction apparatus √ √ √ x √ Functional Facility for Oxygen Administer √ √ √ x √ Functional Foetal Doppler/CTG √ x x x x Functional Mobile light √ x x x x Delivery Tables √ x x x x Functional Autoclave √ √ x x √ Functional ILR and Deep Freezer √ √ √ x √ Emergency Tray with emergency injections √ √ √ x √ MVA/ EVA Equipment √ x √ x √ Functional phototherapy unit √ x √ x x Dialysis Equipment x x x x x O.T Equipment O.T Tables √ x x x x Functional O.T Lights, ceiling √ x x x x Functional O.T lights, mobile √ x x x x Functional Anaesthesia machines √ x x x x Functional Ventilators x x x x x Functional Pulse-oximeters √ x x x x Functional Multi-para monitors √ x x x x Functional Laparoscopes √ x x x x Functional C-arm units x x x x x Functional Autoclaves (H or V) √ x x x x Laboratory Equipment Functional Microscope x √ √ x √ Functional Hemoglobinometer √ √ √ x √ Functional Centrifuge √ √ √ x √ Functional Semi autoanalyzer x √ √ x √ Reagents and Testing Kits √ √ √ x √ Functional ECG machines x x x x x Sources: Supportive supervision checklist, DPMU Haridwar
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Table shows that in the female district hospital as well as CHCs equipment such as Dialysis Equipment, Functional Ventilators, Functional Surgical Diathermies, Functional C-arm units, Functional Microscope, Functional Ultrasound Scanners, Functional C.T Scanner, Functional X-ray units, Functional ECG machines are not available. Some equipment’s are not available at both CHC as well as PHC. Cold chain was available in all the visited health facilities and manages properly by the cold chain technician by ELVIN machine. Figure 5. Health equipment’s in the health facilities
Figure 1: SNCU in district hospital Figure 2: X-Ray machine
Figure 3: Platelets incubator testing machine Figure 4: Dental equipment
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Figure 5: Blood storage unit in district Figure 6: Weight machine hospital
3.6 DRUGS All kind of drugs which were useable in the health facilities were available in the health facilities according to the MOIC and Pharmacists. Some medicine can have brought from the Pradhan Mantri Bhartiya Jan Ausadhi Kendra in very low cost and which is available in very high cost in outside. IFA and Vitamin A syrup is not available in all the health facilities. CBC test not conducted in all visited health facilities such as district hospital, community health centers. Blood bank also not available at CHCs so critical cases always refer to the district hospital.
Figure 6. Drugs in health facilities
Figure 1: Medicine store room Figure 2: Generic medicine store
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Table 30. Availability of drugs of the health facilities in 2017 – 18
CHC CHC PHC PHC Districts Drugs Bahadr Bhagw Biharin Imlik Hospital abad anpur agar heda EDL available and displayed √ √ √ x √ Computerised inventory management √ x x x √ IFA tablets √ √ √ x √ IFA syrup with dispenser x X x X x VIT A syrup x X x X √ ORS packets √ √ √ √ √ Zinc tablets x √ √ X √ INJ Magnesium Sulphate √ √ √ X x INJ Oxytocin √ √ √ X x Misoprostol tablets √ √ √ X √ Mifepristone tablets x X x X x Availability of antibiotics √ √ √ x √ Labelled emergency tray √ √ √ x √ Drugs for hypertension, Diabetes, common ailments. √ √ √ √ √ Adequate Vaccine Stock available √ √ √ X √ Supplies
Pregnancy testing kits √ √ √ √ √ Urine albumin and sugar testing kit √ √ √ x √ OCPs √ √ √ x √ EC pills √ √ √ x v IUCDs √ √ √ x √ Sanitary napkins x √ x x √ Essential Consumables
Gloves, Mackintosh, Pads, bandages, and gauze etc. √ √ √ x √ Lab Services
Haemoglobin √ √ √ x √ CBC x X x x x Urine albumin and sugar √ √ √ x √ Blood sugar √ √ √ x v RPR x X x x √ Malaria √ √ √ x √ T.B √ √ √ √ √ HIV √ √ √ x √ Liver function tests(LFT) x x x x x Ultrasound scan (Ob.) x x x x x Ultrasound Scan (General) x x x x x X-ray √ x √ x x ECG x x x x x Endoscopy x x x x x Others , Please specify x x x x x Blood bank/ Blood storage unit Functional blood bag refrigerators √ x x x x Sufficient no. of blood bags available √ x x x x Check register for number of blood √ x x x x Sources: Supportive supervision checklist, DPMU Haridwar
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3.7 SERVICE DELIVERY IN LAST TWO YEARS Table 31. Service delivery in year 2017-18
Service utilization District CHC PHC CHC PHC parameter hospital Bahadrabad Biharinagar Bhagwanpur Imlikheda OPD 66803 - - 40906 15472 IPD 10205 - - 848 19 Total deliveries 4561 - - 1515 3 conducted No. of admission in 761 - - 64 - NBSUs No of sick children - - - 14 32 referred No of pregnant women 227 - - 25 26 referred ANC 1 registration 2617 - - 6149 222 ANC 3 coverage 1843 - - 3749 219 No. of IUCD incretions 65 - - 872 40 No. of PPIUCD incretions 1222 - - 18 - No of Vasectomy - - - - - No of Minilab - - - - - No. of children fully 1557 - - 222 - immunized No. of children given NA - - 98 - Vitamin A No. of MTPs conducted 170 - - - - Maternal deaths 1 - - 3 - Still births 49 - - 7 4 Neonatal deaths 9 - - 9 - Infant deaths - - - 12 - No. of C-section 606 - - - - conducted No of children given ORS - - - - - + ZINC No of neonates initiated breast feeding within 4507 - - - - one hour Sources: Supportive supervision checklist, DPMU Haridwar
During our field visit we have found that only three health facilities have availability of service delivery. Mostly service delivery has reported in district hospital of Haridwar followed by CHC Bhagawanpur and PHC Imlikheda. Whereas in the CHC Bahadrabad and PHC Biharinagar have no such type of facilities were available.
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3.8 MATERNAL HEALTH, DELIVERY AND CHILD HEALTH Table 32. Block wise maternal health indicators of Haridwar district 2017 – 18
Institutional Block 3 ANC registered Home deliveries deliveries Haridwar 46.5 20.9 79.1 Bahadrabad 34.2 7.4 92.6 Bhagwanpur 60.7 71.1 28.9 Khanpur 65.1 34.7 65.3 Laksar 43.2 41.3 58.7 Narsan 46.1 30.3 69.7 Sources: HMIS data
Maternal and child health is key component of health services, whereas at the Haridwar district during the last financial year only 79.1 % Institutional delivery have reported. However, the maximum 3 ANC registration have reported in Khanpur block of Haridwar district. While in the Bhagwanpur the highest numbers of home deliveries are reported in the block. Thus, its indicate most of health facilities at district as well as community and primary health centre were far away, to improve the health situation at ground realities.
Table 33. Maternal health indicators in Haridwar District 2017 – 18
Home deliveries Block TT2 Live Birth Total birth SBA Assisted Haridwar 86.0 12.5 99.0 98.8 Bahadrabad 73.9 7.4 99.3 99.7 Bhagwanpur 101.5 5.7 98.0 98.2 Khanpur 96.7 15.3 97.2 101.8 Laksar 86.2 8.6 98.7 98.4 Narsan 97.8 37.1 98.0 98.3 Sources: HMIS data Recent time maternal health is an important concern for reproductive health research and the major focus have been given to the institutional deliveries at all health facilities centre. During the last financial year, it is observed that in home deliveries through SBA assisted is higher in Khanpur block of Haridwar. While the lowest percentage have reported in the Bahadrabad block 7.4 %.
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3.9 MATERNAL DEATH Only one maternal death occurs in district hospital because of patient not reached on time in the hospital. In both CHCs no maternal death was reported in register record. According to the MOIC, and doctor, High risk patient immediately refer to the nearby district hospital. Hygiene and cleanliness maintained by DAI in all the visited health facility. Ambulance facility also provide for the pregnant women to pick and drop facilities. Figure 7. Labour room, OT and maternity ward
Figure 1: Labour room in district hospital Figure 2: Maternity ward in district hospital
Figure 3: Labour room in CHC, Bhagwanpur Figure 4: Labour room in PHC, Imlikhera
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3.10 CHILD HEALTH Table 34. Block wise analysis of immunization in the last financial year
DPT Pentavalent Block OPV at Birth BCG Measles Full 1 2 3 1 2 3 Haridwar 16,676 28,236 374 392 424 30,342 29,512 29,397 19,279 19,012 Bahadrabad 7,260 8,774 349 366 383 9,619 9,347 9,016 5,766 5,597 Bhagwanpur 1,702 4,136 6 3 2 4,952 4,755 4,767 3,124 3,115 Khanpur 539 884 2 2 0 919 918 908 614 578 Laksar 591 2,168 0 0 0 2,367 2,285 2,473 1,831 1,758 Narsan 2,115 4,836 2 9 26 5,126 5,107 4,989 3,249 3,241 Sources: Supportive supervision checklist, DPMU, Haridwar
Government of India, given major focus to improve full Immunization coverage in all the district. In the Haridwar district maximum OPV at birth have reported in the Bahadrabad block followed by Narsan, Bhagwanpur, Khanpur and Laskar. Whereas very less number of BCG dose given to children were reported in Khanpur. Considering the figures of full immunization in Bahadrabad block maximum number of children were received vaccination compared to others block.
3.11 SNCU, NRC, NBSU, NBCC In the visited district hospital SNCU and NRC wing are available with 10 bedded facilities. But in district hospital only one paediatrician is available and he handled both wing, also staff nurse is less in number. During visit time not any single child was admitted. In a week ago children who are admitted they all get leave because doctor have to go to on personal leave for one week. During this time no patient were admitted before coming to the doctor. In district hospital one nutritionist is also available and she provide guideline about cooking and nutrition for the children who admitted in NRC. For outsider hospital also provide food with the cost of 100 per day. Only NBSU is available in CHC Bahadrabad but not functioning, due to construction work on labour room. For temporary phase delivery room shifted in NBSU and critical cases in behalf of infants they referred to the Roorkee district hospital. 5 bedded NBSU is available in CHC Bhagwanpur. Staff shortage such as Paediatrician is a big problem in both CHCs. So local people face such type of difficulty, mainly due to distance factor- Roorkee district hospital are far from their home place.
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Figure 8. NRC, SNCU and NBCC in health facilities
Figure 1: NRC Wing Figure 2: NRC kitchen
Figure 3: NBSU Figure 4: SNCU
3.12 RASHTRIYA BAL SWASTHYA KARYAKRAM Under RBSK programme number of school identified through RBSK team and provide them proper counselling. RBSK team visited school twice in a week and 6-19-year-old children were identified if any complication they referred to the children for their check-ups. Age group of 13-19 RBSK team provide them suggestion about cleanliness, hygiene practices, and proper nutrition. After 15- 19 age group they suggested about uses of contraception. Contraception and pads provide them free of cost in health facilities, even they took from Aanganbadi. In district RBSK team doing their twice in a week but in CHC Bhagwanpur there is no provision for the RBSK. In CHC Bahadrabad under RBSK 200 peer educator were selected in a village. 2 peer educator works under 1 ASHA. These peer educators are 12th pass. RBSK team provide training to these peer counsellors and with the support of ASHA they visited school, children home and provide them proper counselling about cleanliness, hygiene practices during period, for girls and boys separately hired girl peer counsellor and boy counsellor.
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3.13 JANANI SURAKSHA YOJANA & JANANI SHISHU SURAKSHA KARYAKRAM Table 35. Status of JSY payments in district in the last financial year
Status Of Payments For ( in per cent) Record Maintenance Deliveries Home Non Institutional Deliveries Brought Available Updated Deliveries Updated by ASHAs 79.1 20.9 - √ √ - Sources: Supportive supervision checklist, DPMU, Haridwar Government has given more focus on programme Janani suraksha yojana specifically for rural women and their child. There were a large number of women and children have benefited. To successful run the programme at rural area ASHA have playing an important role whereas at the block level with the huge population there were very ASHA was working at the ground. With the successful implementation on JSY programme, it can be seen that in the district of Haridwar a large number of Institutional deliveries have been reported.
Figure 9. Meeting with ANM and ASHAs.
Figure 1: ASHA help desk in DH Figure 2: Meeting with ANM and ASHAs
Figure 3: Interaction with ASHAs Figure 4: Conversation with ASHAs
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3.14 FAMILY PLANNING In Haridwar district for family planning mostly women are using IUCD, PPIUCD and condoms. In district hospital women have reported to prefer PPIUCD and IUCD. They are also giving preference to condoms. In Bahadrabad and Bhagwanpur with the conversation of MOIC we knew that women using mostly condoms. In visited PHCs and SCs with the conversation of MOs in PHC and ANM of SCs we knew that women are preferring PPIUCD and Condoms. In visited health facilities we knew that women are doing Sterilization, specially laparoscopy, and only 5% male started sterilization from the last financial year. In CHC Bahadrabad and Bhagwanpur every month sterilization camp organized and doctors call from the outside for sterilization.
3.15 INFORMATION EDUCATION AND COMMUNICATION
IEC display is important for the health and health facilities because it spread awareness about all kind of illness. People can easily read it as well as update about various kind of illness and programmes. IN district hospital and CHC Bahadrabad and Bhagwanpur IEC display were available and updated, also in PHC IEC display were sufficient but not in SCs. Figure 10. IEC display in the health facilities.
Figure 1: IEC display about Diabetes Figure 2: IEC display about T.B
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Figure 3: IEC display about JSY Figure 4: IEC display about immunization
Figure 5: IEC display about delivery in Figure 6: IEC display about immunization government hospital
3.16 COMMUNITY PROCESS
The Community level health workers such as ASHAs, play an important role in promoting institutional deliveries which have a big impact on the health of the mother and the new- born at community and primary health centre. According to the information provided by the ACMO ASHA work are satisfactory in the district Haridwar. With the conversation of ASHAs I knew that they get incentives not on time in Bahadrabad district. ANC registration done on time by ASHAs told data account manager, doctors and data manager. But the problem with ASHAS is here that in any complication cases when doctors refer high risk cases in district hospital or anywhere, and women are registered from the referral health facilities that time ASHAs not getting any incentives.
3.17 DISEASE CONTROL PROGRAMME
In district hospital Under disease control programme 31 T.B patient were successfully completed their check-ups from the month of march to till now. Whereas 17 leprosy patient also successfully completed their check-ups. In CHC Bahadrabad only Leprosy, RNTCP and malaria programme is running. In CHC Bhagwanpur TB, malaria patient comes for their check- ups and high risk patient referred to the district hospital Roorkee. In both visited PHCs under disease control programme only TB and malaria patient come for their check-ups and doctor check them and give medicine, but in high risk situation they refer to the patient in nearby district hospital and CHCs.
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3.18 HMIS/MCTS Maintaining the data will be help for the programme and policy purpose. Under the HMIS section all data related to health aspect had properly filled by the data operator manager. This data is also uploaded on HMIS Portal for public uses. These all health data information was provided by the ASHA worker. Our visited centre at the district hospital, CHC Bahadrabad and Bhagwanpur proper data have maintained by data entry operator and respective of all PHC data were reported at nearby CHC. While under the MCTS mostly DPMs and BCPM have track beneficiary household through mobile with the help of ASHA worker. On that basis ASHA were received the incentives according to their work progress.
3.19 AYUSH Under Ayush programme in the district Haridwar only Ayurveda and Homeopathy doctors are in working position. Both doctors check general as well as ANC patients. Both type of medicine Ayurvedic and Homeopathic are available and doctor provide this medicine. In CHC Bahadrabad and Bhagwanpur under Ayush unit only Homeopathy doctor is available and doctor check both general patient as well as ANC, and also give homeopathic medicine to the patient.
3.20 STATEMENT OF NHM EXPENDITURE IN HARIDWAR DISTRICT 2017-18 Table 36. Fund utilization in the last financial year.
District women hospital Funds Proposed Received Utilised Untied fund expenditure 3,19,000 1,51,082 1,51,082 Annual maintenance grant 4,00,000 3,91,030 3,91,030 CHC Bhadrabad Untied fund expenditure ( Rs 50,000/25,000- check % - - - expenditure) Annual maintenance grant ( Rs 1,00,000/50.000 - - - CHC Bhagwanpur Untied fund expenditure ( Rs 50,000/25,000- check % 4,54,540 4,54,540 4,54,425 expenditure) Annual maintenance grant ( Rs 1,00,000/50.000) - - - PHC Imlikheda Untied fund expenditure ( Rs 50,000/25,000- check % - - - expenditure) Annual maintenance grant ( Rs 1,00,000/50.000 7,00,000 7,00,000 7,00,000 SC Jamalpur kala Untied fund expenditure ( Rs 10,000- check % expenditure) 10,000 10,000 10,000 Annual maintenance grant ( Rs 10.000-check expenditure - - - SC Imlikheda Untied fund expenditure ( Rs 10,000- check % expenditure) 10,000 10,000 10,000 Annual maintenance grant ( Rs 10.000-check expenditure - - - Sources: Supportive supervision checklist, DPMU, Haridwar
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4. FACILITY WISE OBSERVATIONS `
4.1 DISTRICT HOSPITAL Figure 11. Health facility in district hospital
Figure 1: District hospital, Haridwar Figure 2: Patients in queue for prescription
Figure 3: Maternity ward Figure 4: Emergency ward
Figure 5: Rain basera Figure 6: PNC ward
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District hospital is running under government building and it has separated from the women district hospital where all health facilities are available for the female. Toilets are not attached with maternity ward as well as general ward.
Quarters are available for the MOs, permanent staff nurse and doctors. This district hospital has power back up facility through generator. Water supply is available 24*7 hours in toilet as well as for drinking.
In district women hospital two MBBs, one LMO, one anaesthetic, one paediatrician are available. Every day different colour bedsheet has been changed in all units like as maternity ward, general ward, and also in SNCU.
Per day OPD load including ANC check- ups is 230-250.
District women hospital has 34 bedded and mostly time overloaded situations make on bed.
Training provided in IUCD, PPIUCD, SBA, and NSSK.
In district hospital one 108 and one 102 ambulances are available. All health equipment’s, drugs, stretcher also were available in the both hospital.
All drugs are available and equipment’s are functional in district hospital. In the condition of shortage of medicine, they discussed with CMO and medical officer and fulfilled it as soon as possible.
Under disease control programme 31 T.B patient were successfully completed their check-ups from the month of March to till now. Whereas 17 leprosy patient also successfully completed their check-ups.
Although under family planning programme no counsellor was available and one staff nurse gives counselling. She provides counselling during ANC check-ups. Mostly women preferring condoms for family planning and vey less no of women preferring PPIUCD and IUCD.
Under AYUSH programme Ayurveda and homeopathy wing are available in district hospital. Both doctors check general as well as ANC patients. Both type of medicine Ayurvedic and Homeopathic) are available and doctor provide such type of medicine.
In district hospital 450-500 delivery conducted in a month. Not any maternal death is reported in the DWH from the last 6 months. Labour room was clean and OT was also available in DH.
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Twelve bedded SNCU are available and all equipment’s were in functioning condition. During our visit in the in the district hospital no child was admitted that time. SNCU had personal kitchen and cook were available and she provide meal to the children according to the dietician.
HIV test has been conducted here and 3 has been found positive from the last financial year. All other test facilities are available in DH like as urine, sugar, malaria etc.
This district hospital has blood bank. Also 3 lab technician in pathology department are available. Through different NGO and organisation had organise blood donation camp in this DH, So DH never phasing lack of blood.
In the hospital C- section delivery has conducted and only one gynaecologist is available here. While in the hospital operation theatre are available and only laparoscopy has conducted in OT.
Women received their JSY payment after delivery in their account. ASHAs have also received their payments after proper competition of work. Under the JSSK programme drugs and ambulance drop back to home facility are provided to the beneficiaries. For diet is not proper and sufficient available for them.
IEC display were updated and present in different section.
Three data operating manager are available in DH and handle different kind of work such as HMIS data entry, drugs and others.
Under KAYA KALP scheme district hospital won second price for hygiene and cleanliness.
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4.2 COMMUNITY HEALTH CENTER BAHADRABAD Figure 12. Health facility in CHC
Figure 1: CHC, Bahadrabad Figure 2: Lab facility
Figure 3: Toilet Figure 4: Maternity ward
CHC Bahadrabad running under the government building and quarters are available for all staff. Also quarters make in between of this CHC.
This CHC has 30 bedded capacities. While power backup maintained through the generator.
This CHC is facing HR problem. Only 2 MBBS doctor including MOs, 1 pharmacist, 1 dentist, 1 eye specialist and lab technician handled this CHC. C-section cases mostly referred to the district hospital due to of unavailability of gynaecologist.
In the centre only one 102 ambulances are available and 108 ambulances are provided services to the patients on call. All equipment’s and essential drugs are available in ambulance and pilots are well knowledgeable about their work and responsibility.
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Per day OPD load is 200 and ANC OPD is 100. This CHC has charge Rs/ 10 for one patient for fifteen days. ANC and BPL have not paid any cost. All kind of test are also free for ANC and BPL.
JSY payment not being given before discharge. For diet this CHC hired a canteen and diet being provided free of charge.
All mothers are initiating for breast feeding within one hour of normal delivery. Mothers are not staying 48 hours after delivery.
All types of records like OPD, IPD, ANC, PNC, labour room, OT, immunization, drug stock, payment under JSY, referral cases, anaemic pregnant women related register were regularly maintained by the doctors as well as staff.
All IEC displays list of drugs, JSSK entitlement, protocol poster, timing of the health facilities, doctors are available.
3-4 deliveries have been conducted in a day and in a month the ratio is 50-60. Shortage of gynaecologist C-section delivery almost referred to the district hospital. No maternal death occurs in the last financial year.
Mostly women not preferring PPIUCD for the family planning they preferring condoms. One counsellor is available in this CHC for the family planning and she counselled them during ANC check-ups.
Only NBSU is available in this CHC but not in functioning now because of construction of labour room. For temporary phase delivery room shifted in NBSU and critical cases in behalf of infants they referred to the Roorkee district hospital.
For BMW in this CHC one private tender comes after a day in a week.
Untied fund was utilized for cleanliness, gardening, building repairing, water supply, caterers, and IEC display.
Under disease control programme only Leprosy, RNTCP and malaria programme is running.
Meeting gap found under RKS. Last time meeting held in the month of march and after that it held in the month of November.
Under RBSK programme counsellor provide proper counselling to the children and aware them for proper diet, cleanliness and hygiene practices. They identified students and if found any major complication they started to provide them treatment.
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In this CHC ultra sound facilities are not available and patient done ultra sound in some private hospital or clinics.
Cold chain available and through EVIN software it managed and monitor easily.
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4.3 COMMUNITY HEALTH CENTER BHAGWANPUR Figure 13. Health facility in CHC
Figure 1: CHC, Bhagwanpur Figure 2: Staff quarter
Figure 3: Maternity ward Figure 4: Under construction OT
Figure 5: Pit Figure 6: Cold chain
CHC Bhagwanpur running under the government building and quarters are available for all staff.
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This CHC has 16 bedded capacities. While power backup maintained through the generator.
This CHC is facing HR problem. Only 3 MBBS doctor including MOs, where 2 are in contract basis, 1 pharmacist, 1 optimist and lab technician handled this CHC. C-section cases mostly referred to the district hospital due to of unavailability of gynaecologist.
In the centre only one 102 ambulances are available and one 108 ambulances are provided services to the patients. All equipment’s and essential drugs are available in ambulance and pilots are well knowledgeable about their work and responsibility.
Per day OPD load is 180-250. This CHC has charge Rs/ 10 for one patient for fifteen days. ANC and BPL have not paid any cost. All kind of test are also free for ANC and BPL.
JSY payment not being given before discharge. For diet this CHC hired a hotel, who provide breakfast, lunch and dinner and diet being provided free of charge.
This CHC have less number of beds that’s why they can’t stay for PNC for long time. In any emergency situation they stay to the patient after delivery.
All types of records like OPD, IPD, ANC, PNC, labour room, OT, immunization, drug stock, payment under JSY, referral cases, anaemic pregnant women related register were regularly maintained by the doctors as well as staff.
All IEC displays list of drugs, JSSK entitlement, protocol poster, timing of the health facilities; doctors are available and maintained properly.
1-2 deliveries have been conducted in a day and in a month the ratio is 50-60. Shortage of gynaecologist C-section delivery almost referred to the district hospital Roorkee.3 maternal deaths and 17 neonatal deaths were found in the last financial year.
Mostly women not preferring PPIUCD and IUCD for the family planning: they are preferring condom.
5 bedded NBSU is available in this CHC and in functioning. For temporary phase delivery room shifted in NBSU and critical cases in behalf of infants they referred to the Roorkee district hospital.
For BMW in this CHC one private tender comes after a day in a week.
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Untied fund proposed for this CHC is 454540 out of that a total amount received was 454540. which was utilized for cleanliness, gardening, building repairing, water supply, caterers, and IEC display.
Under disease control programme only TB, malaria patient comes for their check-ups and high risk patient referred to the district hospital Roorkee.
ASHAs meeting held in CHC wise quarterly and PHC wise it held monthly.
In this CHC ultra sound facilities are not available and patient done ultra sound in district hospital Roorkee in free of cost.
Cold chain available and through EVIN software it managed and monitor easily.
Under Ayush only Homeopathy and Ayurvedic doctor is available. Doctor check both general patient as well as ANC, and give homeopathic and Ayurvedic medicine to the patient.
64% vaccination coverage found in this CHC because of migrated population.
Data entry operator is available and he entered HMIS data on HMIS portal. As well as he maintaining JSY payment data.
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4.4 PRIMARY HEALTH CENTER IMLIKHEDA Figure 14. Health facility in Primary health centre
Figure 1: PHC, Imlikheda Figure 2: Pathology lab
Figure 3: Toilets Figure 4: Bio medical waste pit
The primary health center (PHC) Imlikhera was easily accessible with road connectivity and functioning in a government building. The PHC Imlikhera was converted in the health and wellness center. A staff quarter was not available in the facility. The Human Resource designated at health facility are: 2 MO, 2 ANM, 1 LTs, 1 Pharmacists, 1 Ward boy and 1 swiper at the PHC. A homeopathic doctor was available in PHC. Labour room of the PHC is functional. Toilet found attached to the labour room and clean. Only 2 deliveries conducted at the health facility in a month and the facility was not conducted 24*7 hours’ delivery. The facility has an average OPD load of 100-150 patients per day, and only 4 beds are available. Toilets and washrooms are available and clean.
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Electricity was available with power backup like invertor and generator and water facility was available in 24*7. The facility has B.P instrument and stethoscopes for blood pressure, Sterilized delivery sets, Functional neonatal, Pediatrics and Adult Resuscitation kit, Adult weighing machine, Functional Radiant Warmer, Functional ILR and Deep Freezer and needle hub cutter are available. All laboratory equipment’s are available. The following tests can happen in the health facility: Hemoglobin, Malaria, HIV T.B, Blood group, Urine test, Serum Bilirubin test, RPR (Rapid Plasma Regain), and Sugar, Blood Sugar but CBC test was not available. Drugs such as IFA tablets, Vit. A syrup, ORS packets, Zinc tablets, Misoprostol. Drugs for hypertension, Diabetes, common ailments e.g. PCM, metronidazole, anti-allergic drugs etc. are in stock. There was no facility of Bio-medical waste (BMW), it was collected garbage and pit in to underground. Untied funds amounting to Rs/ 7,00,000 lakhs are provided every year around June/July. It is spent towards cleaning, procuring supplies and stationery. The staff indulges in counselling for family planning. Options available for family planning was condom. During the visit, All IEC display found at this PHC. Records are maintained for OPD, IPD, Indoor bed head ticket, Drug Stock.
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4.5 PRIMARY HEALTH CENTER BIHARINAGAR
Figure 15. Health facility in Primary health center
Figure 1: PHC, Biharinagar Figure 2: General ward
Figure 3: Medicine store room Figure 4: AYUSH wing
The primary health center (PHC) was easily accessible with road connectivity and functioning in a government building, Staff quarters are available at PHC, but Doctors and other staff was not residing in this quarter due to security concern. The Human Resource designated at health facility are: MO, 1 ANM, 1 Pharmacists, 1 Ward boy and 1 swiper at the PHC. The facility has an average OPD load of 15-20 patients per day, and only 3 beds are available. Toilets and washrooms are available but not clean. The PHC was running without power backup and water facility available in 24*7. The facility has B.P instrument and stethoscopes for blood pressure. Adult weighing machine and needle hub cutter are also available.
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Drugs such as IFA tablets, IFA syrup with dispenser, Vitamin A syrup, ORS packets, Zinc tablets, Misoprostol. Drugs for hypertension, Diabetes, common ailments e.g. PCM, metronidazole, anti-allergic drugs etc. are in stock. There is no facility of Bio-medical waste (BMW), it was collected garbage and pit in to underground. No IEC display is available inside the facility. Records are maintained for OPD, IPD, Indoor bed head ticket, Drug Stock.
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4.6 SUB CENTER JAMALPUR KALA
Figure 16. Health facilities in Sub Center
Figure 1: Sub centre Jamalpur kala Figure 2: Meeting with ANM& ASHAs
Figure 3: Toilets Figure 4: Baby weight machine
The health facility was easily assessable and run in government building and the facility was situated in community center of the village. It has no ANM quarter available. The facility has 2 ANM, and 11 ASHAs and this facility cover 4 villages. The facility was not a delivery point. No display is available inside the facility. Electricity is available and no Power back up and water facility available in 24*7. Records are maintained for ANC, immunization, Drug Stock and vaccine. This sub center is mostly used for immunization, ANC registration, VHNCD meeting and filed based work. In the last month total 38 ANC have registered at this SC. The facility got new Wi-Fi connection by Panchayat Bhawan. 5 days ANM duties have placed in the village for VHND meeting and immunization.
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ASHA reported that JSY PAYMENT for delivery care was not get during the last 1 year. Drugs such as IFA tablets, IFA syrup with dispenser, vitamin A syrup, ORS packets, zinc tablets, Inj. magnesium sulphate & oxytocin, misoprostol & mifepristone tablets. drugs for hypertension, diabetes, common ailments e.g. PCM, metronidazole, anti- allergic drugs etc. are in stock. The health facility has a functional BP instrument and Stethoscope, sterilized delivery sets neonatal, pediatrics and adult resuscitation kit, weighing machine (adult and infant/new-born), needle cutter.
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4.7 SUB CENTER IMLIKHEDA
Figure 17. Health facilities in Sub Center
Figure 1: Maternity ward, Imlikhera Figure 2: Contraceptives
Figure 3: Weight machine Figure 4: Bio medical waste management
The Sub Centre was run in government building. It has no ANM quarter available. The facility is not a delivery point. There was no facility of Bio-medical waste (BMW), it was collected garbage and pit in to underground. Records are maintained for ANC, immunization, Drug Stock and vaccine. This sub center is mostly used for immunization. Electricity was available with power backup like invertor and water facility was available in 24*7. At sub Centre level 1 ANMs and 11 ASHAs were appointed. They have received training on IUCD, NSSK and SBA. They were conducted immunization camps at village levels and also provide guidelines related to maternal and child health to the ASHAs. ASHAs distribute IFA and other essential drugs to pregnant women. All IEC display found at this Sub Centre.
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5. CONCLUSIONS AND RECOMMENDATIONS
1. In district women hospital per month delivery load is 450-500. While due to shortage of human resources such as Gynaecologist, overloaded can be seen on gynaecologist. As well as only one pedestrian is available who handled SNCU and NRC. For family planning Mostly women preferring PPIUCD, and sterilization not have done in much amount because of shortage of gynaecologist. 2. In Bahadrabad and Bhagwanpur district only normal delivery has been done by the staff nurse, C-section not conducted yet because of shortage of gynaecologist. In both CHCs which are enhancing their labour room because of increasing demands of delivery. NBSU and NBCC are not functioning here because labour room temporarily shifted here. So critical child directly refers to the nearby district hospital. 3. However, in district hospital and both visited CHCs patients have availed the benefit of Pradhan Mantri Generik medicine, which was available at low cost in the hospital 4. All visited community, primary health centre and SC were running under government building, but the available building and resource were not sufficient to manage the load of huge patients. Therefore, there is need to extend or develop new health infrastructure facilities at district, block and village level. 5. Shortage of manpower especially for doctors and fourth grade employees were found as serious issue to maintain the quality of health services. 6. Staffs are not enough for the SNCU in district hospital and in CHCs for NBSU, NBCC staff as well as space are not enough for the children. Both visited health facilities delivery rooms are shifted in NBSU and NBCC that’s why a large space is required for shifting the NBSU and NBCC and delivery room. 7. Training or orientation of HRs at regular interval is needed. The number of health personnel should be increased at the sub-center as it is the first contact point between the primary health care system and the village community. So infrastructures of the Sub-Centers need to be strengthened. 8. In most of the CHC and PHC there were more number of patients of tuberculosis and leprosy case was identified. However, in term of medicine only basic medicine was available. Thus, NHM will more focus on the disease specific intervention programme in the district. 9. During our field visit we found that in the SC Imlikheda in the rainy season it’s not properly functioning because of rainy water entered into the SC, so the NHM need to be shifted this on another place or renew it. 10. Awareness should be created among the mothers about the risks of shifting from 67
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hospitals before 48 hours of delivery. 11. Effective guidelines should be provided to the health facilities about the utilization of allotted funds so that the stagnant funds will not be occurred. 12. The implementation of ASHAs has made a difference with regard to institutional deliveries. To enhancing and promoting the institutional delivery and maternal and child health related work so NHM should provide the incentive amount on time to motivate them for providing better health care services to the mother as well as the children. 13. The PHCs and SCs should be connected with good roads so that it will be accessible easily by the patients. 14. For the security purposes in health facilities NHM should fill the vacant post as soon as possible. 15. NHM should enhance the PNC ward which is needed in the health facilities.
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6. LIST OF CONTACT PERSON
Name Designation Office Dr. Prem Lal Chief medical officer CMO Office Mrs Monika District programme manager CMO Office Mrs Anjana Data manager CMO Office Mrs Reshma RBSK head CMO Office Dr Shikha Jagpangi Chief medical superintendent District Hospital Dr Alpana Lady medical officer District Hospital Iyrin Sister District Hospital Nirmala Sister District Hospital Ankita Sharma Dietician District Hospital Sini Semwal Staff Nurse District Hospital Priyanka Negi Staff Nurse District Hospital Omwati Cook District Hospital Nisha Bora Lab Technician District Hospital Harendar Singh Bist Data Manager District Hospital Smt Amrit Kaur Cold chain Handler District Hospital Manoj Sharma Cold chain Technician District Hospital Ashok Kumar Immunization Head District Hospital Madhuri Rawat Hospital Manager District Hospital Insar Ali Block Programme manager CHC Bahadrabad Banke Lal Pharmacist CHC Bahadrabad Poonam Kumay Staff Nurse CHC Bahadrabad Chandrakanta Staff Nurse CHC Bahadrabad Rita Rani RKSK counsellor CHC Bahadrabad Harsh Chauhan Peer educator CHC Bahadrabad Dr. Vikrant Sirogi MOIC CHC Bhagwanpur Sanjeev Bhardwaj Block programme manager CHC Bhagwanpur Dr. Shailesh Optimist CHC Bhagwanpur Sukhdev Chamali Pharmacist CHC Bhagwanpur Monika Devi Staff Nurse CHC Bhagwanpur Jagdish Singh Negi T.B.H.V CHC Bhagwanpur Yogesh Kumar Dr Deepak Pandey CHC Bhagwanpur Dr. Anita Kaushal MOCH PHC Biharinagar Dr Shailee Sharma L.M.O PHC Biharinagar Pramod Kumar Sengar X-Ray Technician PHC Biharinagar Umesh Verma Lab Technician PHC Biharinagar Pankaj Tiwari S.S.S PHC Biharinagar Dr. Ashok Kumar MOIC PHC Imlikheda Dr Deshpal BMS PHC Imlikheda Dr Diliraman MBBS PHC Imlikheda Dr. Anil Garg MBBS PHC Imlikheda Manish Kumar BPM PHC Imlikheda 69
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Arvind Kumar Lab Technician PHC Imlikheda Preeti Gola ANM SC Jamalpur Kala Rita Rawat ANM SC Jamalpur Kala Snehlata ASHA facilitator SC Jamalpur Kala Babita ASHA SC Jamalpur Kala Geeta ASHA SC Jamalpur Kala Kusum ASHA SC Jamalpur Kala Anuradha ANM SC Imlikheda
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7. ANNEXTURE ANNEXURE-1
National Health Mission Monitoring of District PIP
Population Research Centre, Institute of Economic Growth, Delhi
Evaluation of key indicators of the district
Section 1. Details of demographic & health indicators for the last financial year
No. of Blocks
No. of Villages
Population (2011)
Literacy Rate
Sex Ratio
Child Sex Ratio
Density of Population
Health Indicators Number Percentage/Ratio NMR IMR U5MR MMR TFR Fully immunized children ANC Registration in the first trimester Full ANC Safe Deliveries (Institutional + SBA attended home) Institutional Deliveries No of women received PNC check-ups within 48
hours
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Section 2. Detail of health infrastructure’s in the last financial year Rented building/ Under Health Facility Number available Govt. building const. District hospital
Sub-District hospital First Referral Units (FRUs) CHC PHC Sub Centre Mother & Child Care Centres Adolescent friendly Health Clinic Medical College Skill Labs District Early Intervention Centre Delivery Points
Number Transport Facility Number available Remarks functional 108Intervention Ambulances Centre
CATS
102 Ambulance
Referral Transport
Mobile Medical Units
Section 3: Human Resource as on 31 March, 2018
Position Name Sanctioned Filled Vacant MO’s including specialists
Gynaecologists
Paediatrician
Surgeon
Nutritionist Dental Surgeon LHV
ANM
Pharmacist
Lab technicians
X-ray technicians
Data Entry Operators
Staff Nurse at CHC
Staff Nurse at PHC
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ANM at PHC
ANM at SC
Data Entry Operators
Any other, please specify
Section 4.1. Training status of Human Resource in the last financial year
Position Name SBA BeMOC MTP Minilap/PPS NSV Total Medical Officers
Lady Medical Officers
Staff Nurses
ANM
LHV/PHN
Section 4.2. Training status of Human Resource in the last financial year RTI/STI/HIV Position Name IUCD insertion FIMNCI NSSK Total screening MO LMO Staff Nurses ANM LHV/PHN Lab technician ASHA Other
4.3 Whether received any letter from the district/state informing about the trainings, if yes then for which trainings?
……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………
Section 5.1. Block wise service delivery indicators in the last financial year
Block ANC Registered 3 ANCs Home Deliveries Institutional Deliveries
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Section 5.2. Block wise service delivery indicators of Post Natal Care (PNC) in last financial year PNC between 48 hrs and 14 days after Block PNC within 48 hrs after delivery delivery
Section 5.3. Block wise service delivery indicator in the last financial year
Home Deliveries TT Total Block TT1 SBA Live Birth Still Birth 2 Non-SBA Births assisted
Section 5.4. Status of JSY Payments in district in the last financial year Status of payments for (in per cent) Record maintenance Deliveries Institutional deliveries Home Deliveries brought by Available Updated Non updated ASHAs
Section 5.5. Block wise JSSK Progress in district in the last financial year No. of Beneficiaries under JSSK District Total = Block Transport Diet Drugs Diagnostic Home to Facility to Referral Facility Home
Section 5.6. Maternal Death Review in the last financial year Place of Deaths Major Month Of pregnancy Total Reasons Maternal During During Hospital Home Transit (% of deaths Post Delivery Deaths pregnancy Delivery due to
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reasons given below) (Haemorrha ge/ Obstetric Complicatio ns/ Sepsis/ Hypertensio n/ Abortion/ Others)
Section 6.1. Child Health: Block wise Analysis of immunization in the last financial year
OPV DPT Pentavalent Full Block Target at BCG Measles Immunization birth 1 2 3 1 2 3
Section 6.2. Child Health: Details of infrastructure & Services under Neonatal Health, in the last financial year
whether established in last financial Numbers year (Yes/No) Total SNCU Total NBSU Total NBCC Total Staff in SNCU Total Staff in NBSU Total NRCs Total Admissions in NRCs
Total Staff in NRCs Average duration of stay in NRCs
Section 6.3. Neonatal Health: (SNCU, NRCs & CDR) in the last financial year Total Treatment Outcome Total Treatment Outcome neonate neonate s Discharg Referre Deat LAMA s Discharg Referre Deat LAMA admitte e d h * admitte e d h * d in to d in to 75
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SNCU NBSU
Note- * Leave against medical advise
Section 6.4. Neonatal Health: (SNCU, NRCs & CDR) in the last financial year
Place of Death Major Reasons for death Total Death (% of deaths due to reasons given Hospital Home Transit below)
(Prematurity, Birth Asphyxia,
Diarrhea, Sepsis, Pneumonia, Others)
Section 6.5. Rashtriya Bal Swasthya Karyakram (RBSK), Progress Report in the last two financial years No. of No. of No. of Physicall Children Childre Eye Heart children Ear y Anem Years School Diagnose n Diseas diseas registere Disease challeng ic s d referre e e d ed d 2017-18
2016-17
Section 7. Family Planning achievement in District in the last financial year Oral Emergency Injectable Sterilization IUCD insertions Condoms Pills Contraceptives Contraceptives Block *T *M *F *T *A *T *A *T *A *T *A
Section 8. RKSK Progress in District in the last financial year
No. of No. of IFA No. of RTI/STI Block No of Anemic Adolescents Counsellin Adolescents who tablets cases
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g session attended the given Severe held Counselling Any Anaemic Anaemia conducted sessions
Section 9. Quality in health care services
Bio-Medical Waste Management DH CHC PHC No of facilities having bio-medical pits No. of facilities having colour coded bins Outsourcing for bio-medical waste If yes, name company How many pits have been filled Number of new pits required Infection Control No. of times fumigation is conducted in a year Training of staff on infection control
Section 10. Community process in District in the last financial year Last status of ASHAs (Total number of ASHAs) ASHAs presently working Positions vacant Total number of meeting with ASHA ( in a Year) Total number of ASHA resource centres/ ASHA Ghar Drug kit replenishment No. of ASHAs trained in last year ASHA’s Trained in Digital Literacy 1) Name of trainings received 2) 3)
Section 10.1. Disease control programme progress District (Non-Communicable Diseases) Name of the 2016-17 2017-18 Programme/ No. of cases No. of detected No. of cases No. of detected cases Disease screened cases screened Blindness Mental Health
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Diabetes Hypertension Osteoporosis Heart Disease Obesity Cancer Fluorosis Chronic Lung
Disease Others, if any
Section 10.2. Disease control programme progress district (communicable diseases) Name of the 2016-17 2017-18 Programme/ No. of cases No. of detected No. of cases No. of detected cases Disease screened cases screened Malaria Dengue Typhoid Hepatitis A/B/C/D/E Influenza Tuberculosis Filariasis Japanese
encephalitis Others, if any
Section 11. AYUSH progress District in the last financial year Block No. of facilities with No. of patients No. of AYUSH Doctors AYUSH health centres received treatment
Section 12. Pool Wise Heads Summary Expenditure S.No. Budget Head Budget (As on 31 Dec, 2017) PART I NRHM + RMNCH plus A Flexipool PART II NUHM Flexipool PART III Flexipool for disease control programme PART IV Flexipool for Non-Communicable Dieases
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PART V Infrastructure Maintenance
Section 12.a. Budget Utilisation Parameters Funds 2017-18 S.No Scheme/Programme Sanctioned Utilized 12.1 NRHM + RMNCH plus A Flexipool 12.1.1 Maternal Health 12.1.2 Child Health 13.1.3 Family Planning 12.1.4 Adolescent Health/RKSK 12.1.6 Immunization 12.2. NUHM flexi pool 12.2.1 Strengthening of Health Services 12.3 Flexipool for disease control programme Integrated disease surveillance programme 12.3.1 (IDSP) 12.3.2 National vector borne control programme 12.4.3 National tobacco control programme (NTCP) 12.4.1 National mental health programme (NMHP) National programme for the healthcare 12.4.2 elderly (NPHCE) National Programme for Prevention and 12.4.4 Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) 12.5 Infrastructure 12.5.1 Infrastructure 12.5.2 Maintenance 12.5.3 Basic training for ANM/LHVs
Section 13. HMIS/MCTS progress District in the last financial year
HMIS/MCTS progress, Saharanpur, 2017-18
HMIS/MCTS Remarks
Yes No Is HMIS implemented at all the facilities
Yes No Is MCTS implemented at all the facilities
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Yes No Is HMIS data analysed and discussed with concerned staff at state and district levels for necessary corrective action to be taken in future?
Yes No Do programme managers at all levels use HMIS data
for monthly reviews?
Yes No
Is MCTS made fully operational for regular and effective monitoring of service delivery including
tracking and monitoring of severely anaemic women, low birth weight babies and sick neonates
Yes No Is the service delivery data uploaded regularly
Yes No Is the MCTS call centre set up at the District level to
check the veracity of data and service delivery?
Yes No
Is HMIS data analysed and discussed with concerned staff at state and district levels for necessary corrective action to be taken in future?
ANNEXURE-2
DH level Monitoring Checklist
Name of District: ______Name of Block: ______Name of DH: ______Catchment Population: ______Total Villages: ______Date of last supervisory visit:______Date of visit: ______Name& designation of monitor:______80
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Names of staff not available on the day of visit and reason for absence:______…………………………………………………………………………………………………………… ……………………………………………….
Section I: Physical Infrastructure S.No Infrastructure Yes No Additional Remarks 1.1 Health facility easily accessible from nearest road head Y N 1.2 Functioning in Govt building Y N 1.3 Building in good condition Y N 1.4 Staff Quarters for MOs Y N 1.5 Staff Quarters for SNs Y N 1.6 Staff Quarters for other categories Y N 1.7 Electricity with power back up Y N 1.9 Running 24*7 water supply Y N 1.1 Clean Toilets separate for Male/Female Y N 1.11 Functional and clean labour Room Y N 1.12 Functional and clean toilet attached to labour room Y N Functional New born care corner(functional radiant 1.13 Y N warmer with neo-natal ambu bag) 1.14 Functional Newborn Stabilization Unit Y N 1.16 Functional SNCU Y N 1.17 Clean wards Y N 1.18 Separate Male and Female wards (at least by partitions) Y N 1.19 Availability of Nutritional Rehabilitation Centre Y N 1.2 Functional BB/BSU, specify Y N 1.21 Separate room for ARSH clinic Y N 1.22 Burn Unit Y N 1.23 Availability of complaint/suggestion box Y N Availability of mechanisms for Biomedical waste 1.24 Y N management (BMW)at facility 1.25 BMW outsourced Y N 1.26 Availability of ICTC/ PPTCT Centre Y N 1.27 Rogi Sahayta Kendra/ Functional Help Desk Y N
Section II: Human Resource as on March 31, 2018
S.No Category Sanctioned In-position Remarks if any 2.1 OBG 2.2 Anaesthetist 2.3 Paediatrician 2.4 General Surgeon 81
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2.5 Other Specialists 2.6 MOs 2.7 SNs 2.8 ANMs 2.9 LTs 2.1 Pharmacist 2.11 LHV 2.12 Radiographer 2.13 RMNCHA+ counsellors 2.14 Nutritionist 2.15 Dental Surgeon 2.16 Others
Section III: Training Status of HR in the last financial year
S.No Training No trained Remarks if any 3.1 EmOC
3.2 LSAS
3.3 BeMOC
3.4 SBA
3.5 MTP/MVA
3.6 NSV
3.7 F-IMNCI
3.8 NSSK
3.9 Mini Lap-Sterilisations 3.10 Laproscopy-Sterilisations 3.11 IUCD 3.12 PPIUCD 3.13 Blood storage 3.14 IMEP 3.16 Immunization and cold chain 3.15 Others
Section IV: Equipment S.No Equipment Yes No Remarks 4.1 Functional BP Instrument and Stethoscope Y N 4.2 Sterilised delivery sets Y N Functional Neonatal, Paediatric and Adult 4.3 Y N Resuscitation kit
4.4 Functional Weighing Machine (Adult and child) Y N 4.5 Functional Needle Cutter Y N 4.6 Functional Radiant Warmer Y N 82
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4.7 Functional Suction apparatus Y N 4.8 Functional Facility for Oxygen Administration Y N 4.9 Functional Foetal Doppler/CTG Y N 4.1 Functional Mobile light Y N 4.11 Delivery Tables Y N 4.12 Functional Autoclave Y N 4.13 Functional ILR and Deep Freezer Y N 4.14 Emergency Tray with emergency injections Y N 4.15 MVA/ EVA Equipment Y N 4.16 Functional phototherapy unit Y N 4.17 Dialysis Equipment Y N 4.18 O.T Equipment 4.19 O.T Tables Y N 4.20 Functional O.T Lights, ceiling Y N 4.21 Functional O.T lights, mobile Y N 4.22 Functional Anaesthesia machines Y N 4.23 Functional Ventilators Y N 4.24 Functional Pulse-oximeters Y N 4.25 Functional Multi-para monitors Y N 4.26 Functional Surgical Diathermies Y N 4.27 Functional Laparoscopes Y N 4.28 Functional C-arm units Y N 4.29 Functional Autoclaves (H or V) Y N 4.30 Laboratory Equipment 4.31 Functional Microscope Y N 4.32 Functional Hemoglobinometer Y N 4.33 Functional Centrifuge Y N 4.34 Functional Semi autoanalyzer Y N 4.35 Reagents and Testing Kits Y N 4.36 Functional Ultrasound Scanners Y N 4.37 Functional C.T Scanner Y N 4.38 Functional X-ray units Y N 4.39 Functional ECG machines Y N
Section V: Essential Drugs and Supplies S.No Drugs Yes No Remarks 5.1 EDL available and displayed Y N 5.2 Computerised inventory management Y N 5.3 IFA tablets Y N 5.4 IFA syrup with dispenser Y N 5.5 Vit A syrup Y N 5.6 ORS packets Y N 5.7 Zinc tablets Y N 5.8 Inj Magnesium Sulphate Y N 5.9 Inj Oxytocin Y N 83
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5.1 Misoprostol tablets Y N 5.11 Mifepristone tablets Y N 5.12 Availability of antibiotics Y N 5.13 Labelled emergency tray Y N Drugs for hypertension, Diabetes, common 5.14 ailments e.g PCM, metronidazole, anti-allergic Y N drugs etc. 5.15 Adequate Vaccine Stock available Y N
S.No Supplies Yes No Remarks 5.17 Pregnancy testing kits Y N 5.18 Urine albumin and sugar testing kit Y N 5.19 OCPs Y N 5.2 EC pills Y N 5.21 IUCDs Y N 5.22 Sanitary napkins Y N S.No Essential Consumables Yes No Remarks
5.23 Gloves, Mckintosh, Pads, bandages, and gauze Y N
Section VI: Other Services S.N Remark Lab Services Yes No o s 6.1 Haemoglobin Y N 6.2 CBC Y N 6.3 Urine albumin and sugar Y N 6.4 Blood sugar Y N 6.5 RPR Y N 6.6 Malaria Y N 6.7 T.B Y N 6.8 HIV Y N 6.9 Liver function tests(LFT) Y N 6.1 Ultrasound scan (Ob.) Y N 6.11 Ultrasound Scan (General) Y N 6.12 X-ray Y N 6.13 ECG Y N 6.14 Endoscopy Y N 6.15 Others , pls specify Y N Remark S.NO Blood bank/ Blood storage unit Yes No s
Functional blood bag refrigerators with chart for temperature 6.16 Y N recording
6.17 Sufficient no. of blood bags available Y N
6.18 Check register for number of blood bags issued for BT in last quarter
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Section VII: Service Delivery in Last two financial years
S.No Service Utilization Parameter 2016-17 2017-18 7.1 OPD 7.2 IPD 7.3 Total deliveries conducted 7.4 No. of C section conducted No. of neonates initiated breast feeding within one 7.5 hour No of admissions in NBSUs/ SNCU, whichever 7.6 available No. of children admitted with SAM (Severe Acute 7.7 Malnutrition) 7.8 No. of pregnant women referred 7.9 ANC1 registration 7.1 ANC 3 Coverage 7.11 No. of IUCD Insertions 7.12 No. of PPIUCD Insertion 7.13 No. of children fully immunized 7.13 No. of children given ORS + Zinc 7.13 No. of children given Vitamin A 7.14 Total MTPs 7.15 Number of Adolescents attending ARSH clinic 7.16 Maternal deaths 7.17 Still births 7.18 Neonatal deaths 7.19 Infant deaths
Section VIII: Quality parameter of the facility S.No Essential Skill Set Yes No Remarks 8.1 Manage high risk pregnancy Y N Provide essential newborn care(thermoregulation, 8.2 Y N breastfeeding and asepsis) 8.3 Manage sick neonates and infants Y N 8.4 Segregation of waste in colour coded bins Y N 8.5 Bio medical waste management Y N 8.6 Updated Entry in the MCP Cards Y N 8.7 Entry in MCTS Y N 8.8 Action taken on MDR Y N
Section IX. Record maintenence
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Available and Available Updated Not Remarks/Timeline S.No Record but Not and Available for completion maintained correctly filled 9.1 OPD Register 9.2 IPD Register 9.3 ANC Register 9.4 PNC Register Line listing of severely anaemic 9.5 pregnant women 9.6 Labour room register 9.7 OT Register 9.8 Immunisation Register 9.9 Blood Bank stock register 9.1 Referral Register (In and Out) 9.11 MDR Register 9.12 Drug Stock Register 9.13 Payment under JSY
Section X: IEC Display
S.No Material Yes No Remarks 10.1 Approach roads have directions to the health facility Y N 10.2 Citizen Charter Y N 10.3 Timings of the health facility Y N 10.4 List of services available Y N 10.5 Essential Drug List Y N 10.6 Protocol Posters Y N 10.7 JSSK entitlements ( Displayed in ANC Clinics/, PNC Clinics) Y N 10.8 Immunization Schedule Y N 10.9 JSY entitlements( Displayed in ANC Clinics/, PNC Clinics) Y N 10.1 Other related IEC material Y N
Section XI: Additional/Support Services
S.No Services Yes No Remarks 11.1 Regular Fogging (Check Records) Y N 11.2 Functional Laundry/washing services Y N 11.3 Availability of dietary services Y N 11.4 Appropriate drug storage facilities Y N 11.5 Equipment maintenance and repair mechanism Y N 11.6 Grievance Redressal mechanisms Y N 11.7 Tally Implemented Y N
Qualitative Questionnaires for District Hospital Level
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1. What are the measures being taken or planned for Infection control, bio medical waste management at all facility levels and how IEC is beneficial for health demand generations ( MCH, FP related IEC, services available, working hours, EDL, phone numbers etc.)?
……………………………………………………………………………………………………… ……………………………………………………………………………………………………… …………………………………………………
2. What are the common infrastructural and HR problems faced by the facility?
......
3. Do you face any issue regarding JSY payments in the hospital?
......
4. What is the average delivery load in your facility? Are there any higher referral centres where patients are being referred? ......
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ANNEXURE-3
PHC/CHC (NON FRU) level Monitoring Checklist
Name of PHC/CHC: Name of District: ______Name of Block: ______Distance from Dist. HQ: Catchment Population: _____ Total Villages: ______Date of last supervisory visit:______Date of visit: ______Name& designation of monitor:______Names of staff not available on the day of visit and reason for absence:______…………………………………………………………………………………………………………… ……………………………………………
Section I. Physical Infrastructure Additional S.No. Infrastructure Yes No Remarks 1.1 Health facility easily accessible from nearest road head Y N
1.2 Functioning in Govt. building Y N
1.3 Building in good condition Y N
1.4 Staff Quarters for MOs available Y N
1.5 Staff Quarters for SNs available Y N
1.6 Staff Quarters for other categories Y N
1.7 Electricity with power back up Y N
1.9 Running 24*7 water supply Y N
1.1 Clean Toilets separate for Male/Female Y N
1.11 Functional and clean labour Room Y N
1.12 Functional and clean toilet attached to labour room Y N Functional New born care corner(functional radiant 1.13 Y N warmer with neo-natal ambu bag) 1.14 Functional Newborn Stabilization Unit Y N
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1.15 Clean wards Y N
1.16 Separate Male and Female wards (at least by Partitions) Y N
1.17 Availability of complaint/suggestion box Y N
1.18 Availability of mechanisms for waste management Y N
Section II. Human resource as on March 31, 2018 Remarks if S.No Category Sanctioned In position any 2.1 MO 2.2 SNs/ GNMs 2.3 ANM
2.4 LTs
2.5 Pharmacist 2.6 LHV/PHN 2.7 Others
Section III.Training Status of HR (*Trained in Last Financial Year) Remarks if S.No. Training No Trained any 3.1 BeMOC 3.2 SBA 3.3 MTP/MVA 3.4 NSV 3.5 IMNCI 3.6 F- IMNCI
3.7 NSSK 3.8 Mini Lap 3.9 IUD 3.1 RTI/STI 3.11 Immunization and cold chain 3.12 Others
Section IV. Equipments S.No Equipment Yes No Remarks 4.1 Functional BP Instrument and Stethoscope Y N 4.2 Sterilised delivery sets Y N 4.3 Functional neonatal, Paediatric and Adult Resuscitation kit Y N 4.4 Functional Weighing Machine (Adult and infant/newborn) Y N 4.5 Functional Needle Cutter Y N 4.6 Functional Radiant Warmer Y N 4.7 Functional Suction apparatus Y N 4.8 Functional Facility for Oxygen Administration Y N 4.9 Functional Autoclave Y N 4.1 Functional ILR and Deep Freezer Y N 89
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4.11 Functional Deep Freezer 4.12 Emergency Tray with emergency injections Y N 4.13 MVA/ EVA Equipment Y N
Laboratory Equipment Yes No 4.14 Functional Microscope Y N 4.15 Functional Hemoglobinometer Y N 4.16 Functional Centrifuge Y N 4.17 Functional Semi autoanalyzer Y N 4.18 Reagents and Testing Kits Y N
Section V. Essential drugs and supplies
S.No Drugs Yes No Remarks 5.1 EDL available and displayed Y N 5.2 Computerised inventory management Y N 5.3 IFA tablets Y N 5.4 IFA syrup with dispenser Y N 5.5 Vit A syrup Y N 5.6 ORS packets Y N 5.7 Zinc tablets Y N 5.8 Inj Magnesium Sulphate Y N
S.No Drugs Yes No Remarks 5.9 Inj Oxytocin Y N 5.1 Misoprostol tablets Y N 5.11 Mifepristone tablets Y N 5.12 Availability of antibiotics Y N 5.13 Labelled emergency tray Y N Drugs for hypertension, Diabetes, common ailments e.g 5.14 Y N PCM, metronidazole, anti-allergic drugs etc. 5.15 Adequate Vaccine Stock available Y N S.No Supplies Yes No Remarks 5.17 Pregnancy testing kits Y N 5.18 Urine albumin and sugar testing kit Y N 5.19 OCPs Y N
5.2 EC pills Y N 5.21 IUCDs Y N 5.22 Sanitary napkins Y N S.No Essential Consumables Yes No Remarks 5.23 Gloves, Mckintosh, Pads, bandages, and gauze etc. Y N
Section VI. Other Services S.No Lab Services Yes No Remarks 6.1 Haemoglobin Y N 90
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6.2 CBC Y N 6.3 Urine albumin and Sugar Y N 6.4 Serum Bilirubin test Y N 6.5 Blood Sugar Y N 6.6 RPR (Rapid Plasma Reagin) Y N 6.7 Malaria Y N 6.8 T.B Y N 6.9 HIV Y N 6.1 Others Y N
Section VII. Service Delivery in last two years
S.No Service Utilization Parameter 2016-17 2017-18 7.1 OPD 7.2 IPD 7.3 Total deliveries conducted 7.4 No of admissions in NBSUs, if available 7.5 No. of sick children referred 7.6 No. of pregnant women referred 7.7 ANC1 registration 7.8 ANC3 Coverage 7.9 No. of IUCD Insertions 7.1 No. of PPIUCD insertions 7.11 No. of Vasectomy 7.12 No. of Minilap 7.13 No. of children fully immunized 7.14 No. of children given Vitamin A
S.No Service Utilization Parameter 2016-17 2017-18 7.15 No. of MTPs conducted 7.16 Maternal deaths 7.17 Still birth 7.18 Neonatal deaths 7.19 Infant deaths
Section VII a. Service delivery in postnatal wards
S.No Parameters Yes No Remarks All mothers initiated breast feeding within one hr of 7.1a Y N normal delivery 7.2a Zero dose BCG, Hepatitis B and OPV given Y N 7.3a Counselling on Family Planning done Y N
7.4a Mothers asked to stay for 48 hrs Y N 7.5a JSY payment being given before discharge Y N 7.6a Diet being provided free of charge Y N 91
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Section VIII: Quality parameter of the facility S.No Essential Skill Set Yes No Remarks 8.1 Manage high risk pregnancy Y N Provide essential new-born care (thermoregulation, 8.2 Y N breastfeeding and asepsis) 8.3 Manage sick neonates and infants Y N
8.4 Correctly administer vaccines Y N 8.5 Alternate Vaccine Delivery (AVD) system functional Y N 8.6 Segregation of waste in colour coded bins Y N 8.7 Adherence to IMEP protocols Y N
Section IX: Record Maintenance Available, Available Updated and Not Remarks/Timeline S.No Record but Not correctly Available for completion maintained filled 9.1 OPD Register
9.2 IPD Register 9.3 ANC Register 9.4 PNC Register 9.5 Indoor bed head ticket Line listing of severely 9.6 anaemic pregnant women 9.7 Labour room register
9.8 OT Register 9.9 FP Register 9.1 Immunisation Register 9.11 Updated Microplan 9.12 Drug Stock Register 9.13 Referral Registers 9.14 Payments under JSY
Section X: Funds Utilisation S.No Funds Proposed Received Utilised Untied funds expenditure (Rs. 10.1 50,000/25,000-Check % expenditure) Annual maintenance grant (Rs. 10.2 1,00,000/50,000-Check % expenditure)
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Section XI. Additional/Support Services S.No Services Yes No Remarks 12.1 Regular fumigation (Check Records) Y N 12.2 Functional laundry/washing services Y N 12.3 Availability of dietary services Y N 12.4 Appropriate drug storage facilities Y N 12.5 Equipment maintenance and repair mechanism Y N 12.6 Grievance redressal mechanisms Y N 12.7 Tally Implemented Y N
Qualitative Questionnaires for PHC/CHC Level
1. Population covered by the facility. Is the present infrastructure sufficient to cater the present load? ......
2. Any good practices or local innovations to resolve the common programmatic issues......
3. Any counselling being conducted regarding family planning measures......
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ANNEXURE-4 FRU level Monitoring Checklist
Name of District: ______Name of Block: ______Name of FRU: ______Catchment Population: ______Total Villages: ______Distance from Dist. HQ: _____ Date of last supervisory visit:______Date of visit: ______Name& designation of monitor:______Names of staff not available on the day of visit and reason for absence:______
Section I. Physical Infrastructure
S.No Infrastructure Yes No Additional Remarks
1.1 Health facility easily accessible from nearest road head Y N 1.2 Functioning in Govt. building Y N 1.3 Building in good condition Y N 1.4 Staff Quarters for MOs Y N 1.5 Staff Quarters for SNs Y N 1.6 Staff Quarters for other categories Y N 1.7 Electricity with power back up Y N 1.9 Running 24*7 water supply Y N 1.1 Clean Toilets separate for Male/Female Y N 1.11 Functional and clean labour Room Y N 1.12 Functional and clean toilet attached to labour room Y N Functional New born care corner (functional radiant 1.13 Y N warmer with neo-natal ambu bag) 1.14 Functional New-born Stabilization Unit Y N 94
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1.16 Functional SNCU Y N 1.17 Clean wards Y N 1.18 Separate Male and Female wards (at least by partitions) Y N 1.19 Availability of Nutritional Rehabilitation Centre Y N 1.2 Functional BB/BSU, specify Y N 1.21 Separate room for ARSH clinic Y N 1.22 Availability of complaint/suggestion box Y N Availability of mechanisms for Biomedical waste 1.23 Y N management (BMW)at facility 1.23a BMW outsourced Y N 1.24 Availability of ICTC Centre Y N
Section II. Human resource as on March 31, 2018 In S.No. Category Sanctioned Remarks if any Position 2.1 OBG 2.2 Anaesthetist 2.3 Paediatrician 2.4 General Surgeon
2.5 Other Specialists 2.6 MOs
2.7 SNs
2.8 ANMs 2.9 LTs
2.1 Pharmacist 2.11 LHV 2.12 Radiographer 2.13 RMNCHA+ counsellors 2.14 Others
Section III. Training status of HR
S.No. Training NoTrained Remarks if any 3.1 EmOC 3.2 LSAS 3.3 BeMOC
3.4 SBA 3.5 MTP/MVA 3.6 NSV
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3.7 F-IMNCI 3.8 NSSK 3.9 Mini Lap-Sterilisations 3.1 Laproscopy-Sterilisations 3.11 IUCD 3.12 PPIUCD 3.13 Blood storage 3.14 IMEP 3.16 Immunization and cold chain 3.15 Others
Section IV: Equipment S.No Equipment Yes No Remarks 4.1 Functional BP Instrument and Stethoscope Y N 4.2 Sterilised delivery sets Y N Functional Neonatal, Paediatric and Adult 4.3 Y N Resuscitation kit 4.4 Functional Weighing Machine (Adult and child) Y N 4.5 Functional Needle Cutter Y N 4.6 Functional Radiant Warmer Y N 4.7 Functional Suction apparatus Y N 4.8 Functional Facility for Oxygen Administration Y N 4.9 Functional Autoclave Y N 4.1 Functional ILR and Deep Freezer Y N 4.11 Emergency Tray with emergency injections Y N 4.12 MVA/ EVA Equipment Y N 4.13 Functional phototherapy unit Y N Laboratory Equipment 4.1a Functional Microscope Y N 4.2a Functional Hemoglobinometer Y N 4.3a Functional Centrifuge Y N 4.4a Functional Semi autoanalyzer Y N 4.5a Reagents and Testing Kits Y N
Section V: Essential Drugs and Supplies Ye S.No Drugs No Remarks s 5.1 EDL available and displayed Y N 96
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5.2 Computerised inventory management Y N 5.3 IFA tablets Y N 5.4 IFA syrup with dispenser Y N 5.5 Vit A syrup Y N 5.6 ORS packets Y N 5.7 Zinc tablets Y N 5.8 Inj Magnesium Sulphate Y N 5.9 Inj Oxytocin Y N 5.1 Misoprostol tablets Y N 5.11 Mifepristone tablets Y N 5.12 Availability of antibiotics Y N 5.13 Labelled emergency tray Y N Drugs for hypertension, Diabetes, common ailments 5.14 Y N e.g. PCM, metronidazole, anti-allergic drugs etc. 5.15 Adequate Vaccine Stock available Y N
S. No Supplies Yes No Remarks 5.17 Pregnancy testing kits 5.18 Urine albumin and sugar testing kit 5.19 OCPs 5.2 EC pills 5.21 IUCDs 5.22 Sanitary napkins S.No Essential Consumables Yes No Remarks 5.23 Gloves, Pads, bandages, and gauze etc.
Section VI. Other services
S.No Lab Services Yes No 6.1 Haemoglobin Y N 6.2 CBC Y N 6.3 Urine albumin and sugar Y N 6.4 Blood sugar Y N 6.5 RPR Y N 6.6 Malaria Y N 6.7 T.B Y N 6.8 HIV Y N 6.9 Liver function tests(LFT) Y N 6.1 Others , pls specify Y N
S.No Blood bank / Blood Storage Unit Yes No Functional blood bag refrigerators with chart for temp. 6.11 Y N recording 6.12 Sufficient no. of blood bags available Y N
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Check register for number of blood bags issued for BT 6.13 in last quarter
Section VII: Service Delivery in last two financial years S.No Service Utilization Parameter 2016-17 2017-18 7.1 OPD 7.2 IPD MCTS entry on percentage of women registered in the 7.3 first trimester 7.4 No. of pregnant women given IFA 7.5 Total deliveries conducted 7.6 No. of C section conducted 7.7 No of admissions in NBSUs/ SNCU, whichever available No. of children admitted with SAM (Severe Acute 7.8 Anaemia) 7.9 No. of sick children referred 7.1 No. of pregnant women referred 7.11 ANC1 registration 7.12 ANC 3 Coverage 7.13 No. of IUCD Insertions 7.14 No. of PPIUCD insertions 7.15 No. of children fully immunized 7.16 No. of children given Vitamin A 7.17 Total MTPs
7.18 Number of Adolescents attending ARSH clinic 7.19 Maternal deaths, 7.2 Still births 7.21 Neonatal deaths, 7.22 Infant deaths
Section VII a: Service delivery in post natal wards S.No Parameters Yes No Remarks All mothers initiated breast feeding within one hour of 7.1a Y N normal delivery
7.2a Zero dose BCG, Hepatitis B and OPV given Y N
7.3a Counseling on Family Planning done Y N
7.4a Mothers asked to stay for 48 hrs Y N
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7.5a JSY payment being given before discharge Y N
7.6a Diet being provided free of charge Y N
Section VIII: Quality parameter of the facility S.No Essential Skill Set Yes No Remarks 8.1 Manage high risk pregnancy Y N Provide essential new-born care(thermoregulation, 8.2 Y N breastfeeding and asepsis) 8.3 Manage sick neonates and infants Y N
8.4 Segregation of waste in colour coded bins Y N 8.5 Bio medical waste management Y N 8.6 Updated Entry in the MCP Cards Y N 8.7 Entry in MCTS Y N 8.8 Action taken on MDR Y N
Section XI. Record maintenence Available and Available but Remarks/ Updated and S.No Record Not Not Available Timeline for Correctly maintained completion filled 9.1 OPD Register
9.2 IPD Register
9.3 ANC Register
9.4 PNC Register
9.5 Indoor bed head ticket Line listing of severely 9.6 anaemic pregnant women 9.7 Labour room register
9.8 Partographs
9.9 OT Register
9.1 Immunisation Register Blood Bank stock 9.11 register Referral Register (In and 9.12 Out) 9.13 MDR Register
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9.14 Drug Stock Register
9.15 Payment under JSY
Section X. Fund utilisation
S.No Funds Proposed Received Utilised Untied funds expenditure (Rs. 10,000-Check 10.1 % expenditure) Annual maintenance grant (Rs. 10,000- 10.2 Check % expenditure)
Section XI: IEC Display S.No Material Yes No Approach roads have directions to the health 11.1 Y N facility 11.2 Citizen Charter Y N 11.3 Timings of the health facility Y N 11.4 List of services available Y N 11.5 Essential Drug List Y N 11.6 Protocol Posters Y N JSSK entitlements ( Displayed in ANC Clinics/, 11.7 Y N PNC Clinics) 11.8 Immunization Schedule Y N JSY entitlements( Displayed in ANC Clinics/, PNC 11.9 Y N Clinics) 11.1 Other related IEC material Y N
ANNEXURE-5
Sub Centre level Monitoring Checklist
Name of District: ______Name of Block: ______Name of SC: ______Catchment Population: ______Total Villages: ______Distance from PHC: _ 100
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Date of last supervisory visit:______
Date of visit: ______Name& designation of monitor:______Names of staff posted and available on the day of visit: ______Names of staff not available on the day of visit and reason for absence : ______
Section I. Physical Infrastructure
S.No Infrastructure Yes No Remarks 1.1 Sub centre located near the main habitation Y N 1.2 Functioning in Govt. building Y N 1.3 Building in good physical condition Y N 1.4 Electricity with power back up Y N 1.5 Running 24*7 water supply Y N
1.6 ANM quarter available Y N
1.7 ANM residing at SC Y N 1.8 Functional labour room Y N
1.9 Functional and clean toilet attached to labour room Y N
Functional New Born Care Corner (functional radiant warmer with 1.10 Y N neo-natal ambu bag) 1.11 General cleanliness in the facility Y N 1.12 Availability of complaint/ suggestion box Y N 1.13 Availability of deep burial pit for biomedical waste managemen Y N
Section II. Human Resource as on March 31, 2018 Trainings S.No Human resource Numbers Remarks received 2.1 ANM 2.2 2nd ANM
2.4 Others, specify 2.5 ASHAs
Section III.Equipments Available Available but Not S.No Equipment and non- Remarks Available Functional functional 3.1 Haemoglobinometer
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Any other method for Hemoglobin 3.2 Estimation 3.3 Blood sugar testing kits 3.4 BP Instrument and Stethoscope 3.5 Delivery equipment 3.6 Neonatal ambu bag 3.7 Adult weighing machine 3.8 Infant/New born weighing machine 3.9 Needle &Hub Cutter 3.10 Color coded bins 3.11 RBSK pictorial tool kit
Section II. Equipment Available Available but Not S.No Equipment and non- Remarks Available Functional functional 3.1 Haemoglobinometer Any other method for Hemoglobin 3.2 Estimation 3.3 Blood sugar testing kits 3.4 BP Instrument and Stethoscope 3.5 Delivery equipment 3.6 Neonatal ambu bag 3.7 Adult weighing machine 3.8 Infant/New born weighing machine 3.9 Needle &Hub Cutter 3.10 Color coded bins 3.11 RBSK pictorial tool kit
Section V. Essential Supplies S.No Essential Medical Supplies Yes No Remarks 5.1 Pregnancy testing Kits Y N 5.3 OCPs Y N 5.4 EC pills Y N
5.5 IUCDs Y N 5.6 Sanitary napkins Y N Section VI. Service Delivery in the last two years S.No Service Utilization Parameter 2016-17 2017-18 6.1 Number of estimated pregnancies 6.2 No. of pregnant women given IFA 102
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6.3 Number of deliveries conducted at SC 6.4 Number of deliveries conducted at home 6.5 ANC1 registration 6.6 ANC3 coverage 6.7 No. of IUCD insertions 6.8 No. of children fully immunized 6.9 No. of children given Vitamin A 6.1 No. of children given IFA Syrup 6.11 No. of Maternal deaths recorded 6.12 No. of still birth recorded 6.13 Neonatal deaths recorded 6.14 Number of VHNDs attended 6.15 Number of VHNSC meeting attended
Section VII. Record Maintenance Available Sl. Available and but non- Not Record No updated maintaine Available d 7.1 Payments under JSY 7.2 VHND plan 7.3 VHSNC meeting minutes and action taken 7.4 Eligible couple register 7.5 MCH register ( as per GOI) 7.6 Delivery Register as per GOI format 7.7 Stock register 7.8 MCP cards 7.9 Referral Registers (In and Out) List of families with 0-6 years children under 7.1 RBSK 7.11 Line listing of severely anemic pregnant women 7.12 Updated Microplan Vaccine supply for each session day (check 7.13 availability of all vaccines ) Due list and work plan received from MCTS 7.14 Portal through Mobile/ Physically
Section VII A. Funds Utilisation
Sl. No Funds Proposed Received Utilised
Untied funds expenditure (Rs. 10,000- 7a.1 Check % expenditure)
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Annual maintenance grant (Rs. 10,000- 7a.2 Check % expenditure)
Section VIII. IEC display
Sl.No Material Yes No Remarks 8.1 Approach roads have directions to the sub centre Y N 8.2 Citizen Charter Y N 8.3 Timings of the Sub Centre Y N
8.4 Visit schedule of “ANMs” Y N
8.5 Area distribution of the ANMs/ VHND plan Y N
8.6 SBA Protocol Posters Y N
8.7 JSSK entitlements Y N
8.8 Immunization Schedule Y N
8.9 JSY entitlements Y N
8.10 Other related IEC material Y N
Qualitative Questionnaires for Sub-Centre Level
1. Since when you are working here, and what are the difficulties that you face in running the Sub-centre. ……………………………………………………………………………………………… ...…………………………………………………………………………………………… …...... 2. Do you get any difficulty in accessing the flexipool? ……………………………………………………………………………………………… ...………………..………………………………………………………………………… …………………………………………………………………………………………
3. On what head do you spend money of flexi pool? Do you keep record of money spend on the maintenance of infrastructure. ……………………………………………………………………………………………… ...……………...…………………………………………………………………………… ………......
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